Ann Keen: The Department has invested a record £2 billion in dentistry and set up a national access programme to help the national health service deliver its commitment to provide, by 2011, access for all who seek it. It is, of course, the responsibility of Shropshire County primary care trust to plan and develop appropriate services, including dental services, to meet the needs of its resident population.

Andy Burnham: Over 94 per cent. of patients currently see a cancer specialist within two weeks of urgent referral for suspected cancer by their GP. Of those subsequently diagnosed, 85.7 per cent. commenced treatment within 62 days. We have plans to offer patients in England access to diagnostics which may confirm or exclude cancer within one week.

Charlotte Atkins: What contribution are the new GP-led health centres making to greater access to GPs? In my own area, a new health centre is being built in Biddulph. It will be the first time that my constituents have had access to out-of-hours GP services in the evenings and weekends.

Mike O'Brien: I am not surprised that the hon. Gentleman is anxious to avoid there being a change of Government, because we know that the new announced policy of his party may well mean that he will not get his hospital-I understand his concern.
	I shall now deal with the specific point about Purley hospital. As the hon. Gentleman knows, it was to be developed by a private sector company called Translloyd, but as it was unable to get a retail developer on to the site the original plan was declared to be no longer feasible. Translloyd still owns the site and Croydon council is trying to find ways to release it for development. As he knows, the problems arose in 2008.

Mike O'Brien: Information on ambulance turnaround time is not collected by the Department, so in a sense we do not have that information. There is quite a wide range of data in relation to how long people get for lunchtimes and so on. We do, of course, keep response times and that sort of data.

Evan Harris: This morning, I faxed to the public health Minister's office some documents provided to me by the investigative journalist Jane Symons. Those documents show that the Human Fertilisation and Embryology Authority has not only spent millions of pounds pursuing, ultimately failingly, an individual clinician, but that the new chief executive who was brought in to sort out the problem had argued for an externally led inquiry last year. Why has that inquiry not happened? Does the Minister have any proposals to ensure that we know why millions of pounds of taxpayers' money was wasted in that way?

Alison Seabeck: Has my right hon. and learned Friend received any recent requests from the Ministry of Justice for up-to-date estimates of the increase in secondary pleural plaques in order to enable it to come to a decision on a compensation package?

Paul Burstow: I strongly endorse the question asked by my hon. Friend the Member for Carshalton and Wallington (Tom Brake), but may I ask the Minister about another matter, which is related to autism, which has been raised already? Eight out of 10 GPs confirm that they feel they need more training so that they can better understand autism and care for the condition better. What will the Government do to ensure that there is sufficient resources, will and determination to deliver that extra training?

Andrew Dismore: I beg to move,
	That leave be given to introduce a Bill to extend the criteria under which music and sports video works and documentaries lose their exemption from classification.
	Although we passed-or perhaps I should say re-passed-the Video Recordings Bill last week, for technical reasons of urgency it was not practical to propose amendments at that stage. However, some small but highly significant amendments are needed to ensure a more robust regime for child protection. As chair of the Joint Committee on Human Rights, I am an ardent supporter of the right to free speech and expression, but I acknowledge the need for a system of regulation that protects children from harmful content in film, videos and DVDs.
	At the current time, we have a very effective system of classification. The British Board of Film Classification undertakes extensive research into public opinion about what is acceptable content. The BBFC also takes account of research evidence and the advice of psychologists, health care professionals and the police, among others, to produce guidelines, which are updated every four years, that ensure that the content that reaches children in the UK legally in the form of film, DVDs and videos is of an age-appropriate nature and is not harmful to them.
	However, there are gaps in the current regime covering videos and DVDs under the Video Recordings Act 1984-the VRA-and that is what my Bill aims to address. The VRA permits a number of exemptions to the classification regime. Currently they relate not only to video games but to other video works such as music and sports videos. When the Act was passed in 1984, the assumption was that such works were unlikely to cause any concern. My right hon. Friend the Secretary of State for Culture, Media and Sport has recognised that the regime for video games needs to be updated, and the Digital Economy Bill, currently in the other place, is intended to do so. As an aside, it is important to note that in doing so it should in no way undermine the classification regime for linear-non-interactive-material by confusing the responsibilities of the BBFC and those of the Video Standards Council, which is intended to be the statutory authority for classifying video games.
	Except in relation to video games, exemptions are unfortunately not addressed in the Digital Economy Bill. That is a missed opportunity and the reason why I have chosen to bring forward my Bill, which would extend the criteria under section 2 of the VRA to result in specified video works losing exemption from classification. At present, exemption can be claimed for video works such as music and sports videos, which can be very popular with children. Those videos can then be sold to children perfectly legally, even if they contain material that is potentially harmful. My Bill is not intended to extend the VRA to all such exempted works, only to those that contain content that is potentially harmful, such as graphic violence, sexual content falling short of actual sexual activity, imitable dangerous behaviour and drug use. Harmless video works of football matches or artists from the "The X Factor" would remain exempt.
	I have seen some of the less benign sport and music videos myself. For example, the Ultimate Fighting Championship's "UFC Best of 2007" is a combat video featuring martial arts and other fighting techniques. It is available on the high street to any child because its distributor has, quite legally, claimed exemption from BBFC classification under the VRA. It therefore carries no age rating or consumer advice. It contains close-up images of bloody and sustained head blows, which are replayed in slow motion from every conceivable angle to ensure that the best possible view is given of the moments of impact.
	Another work that I have seen is Mötley Crüe's "Greatest Video Hits", which features topless lap dancing and a George W. Bush lookalike in a limousine with a prostitute. The packaging carries an E for exempt rating. Gorgoroth's "Ad Majorem Sathanas Gloriam" features bloody bodies being crucified and a sheep's head on a spike. The American band Slipknot is hugely popular with children, some as young as 10, as well as with teenagers. As expected from the band's reputation, its 10th anniversary DVD features strong content designed to offend parents. Among the most concerning images are those of the consequences of self-mutilation carried out by two teenage girls who have carved the name "Slipknot" into their arm and torso respectively, yet the video carries a letter E in a green triangle indicating that it is exempt from VRA classification.
	Those are all works that parents could and should legitimately expect to be regulated, yet under the current legislation they can all be sold legally without any age restriction. Indeed, it is worth noting that some of that material is rated and age-restricted in other countries. For example, the German film classification body rated the Slipknot DVD as suitable only for those aged 16 and above and the Gorgoroth DVD as suitable only for adults.
	Trading standards officers would welcome the power to prosecute the supply of such unclassified works, but believe that the current legislation exempts them because, for example, they do not contain gross violence, which is a very high threshold, or actual sexual activity. Local Authorities Co-ordinators of Regulatory Services, which represents local authorities on this matter, and the BBFC both support my Bill's minor amendments to section 2 of the VRA in order to broaden the criteria that determine when a video work loses its exemption. Such amendments would enable law enforcement agencies to prosecute the supply of video works that are currently exempted, to protect children from potentially harmful media content.
	I understand that the Government believe that the enforcement authorities can already take such action. However, the view of those who actually have that responsibility is that they cannot, because of the very high bar set by the VRA in order to lose an exemption. For example, had the Slipknot DVD shown the two girls actually in the process of mutilating themselves with a sharp blade, that may well have constituted gross violence under the VRA, but showing the scars after the event almost certainly does not constitute violence sufficient to lose exemption from classification.
	Many responsible members of the home entertainment industry voluntarily seek classification certificates for exempted video works that contain such potentially harmful material. Members of the British Video Association-the BVA-do so even though they are not legally obliged so to do. Their actions in this regard are to be commended. I understand that BVA members support amendments to the Video Recordings Act that would make it a legal obligation on distributors to have potentially harmful material classified, as proposed in my Bill, but there are distributors who do not take the same responsible attitude. That lack of a level playing field serves only to add to consumer confusion.
	A parent looking through a shelf of music or fighting videos, some of which are rated 15 or 18, but some of which are marked E for exempt, is likely reasonably to draw the conclusion that the E video is suitable for younger children. Otherwise, the parents would assume, surely it would have been classified. Yet often, the content of E for exempt videos is virtually identical to or worse than that of an age-restricted product. I would therefore like to urge my hon. Friend the Minister to support this Bill.
	To conclude, this Bill is aimed at modernising the VRA and improving consumer-and most particularly-parental empowerment, to protect their vulnerable children from harmful video material. I commend this Bill to the House.
	 Question put and agreed to.
	 Ordered,
	That Mr. Andrew Dismore, Mike Gapes, Rob Marris, Mr. Virendra Sharma, Mr. Edward Timpson, John Austin, Ms Karen Buck, Clive Efford, Mr. John Whittingdale, Judy Mallaber and Keith Vaz present the Bill.
	Mr. Andrew Dismore accordingly presented the Bill.
	 Bill read the First time; to be read a Second time on Friday 26 February and to be printed (Bill 45).

Stephen O'Brien: The background to this Bill is the fact that social care provision is currently means and needs-tested. The needs test places an individual in one of four categories-critical, substantial, moderate or low. The mean test assesses assets. If someone has more than £23,000, including property, they are liable for the full cost of their care. Those who have more than £14,000 are liable for some of the cost. After the assessment of needs, and if someone is below the means threshold, the council will agree a care plan with them. For those in the critical or substantial groups, that may include entry to residential care; otherwise, care will be provided in the domestic setting. Free personal care will be targeted at critical needs only through regulations to be passed on the back of this Bill.
	I hope that that was a useful scene-setter, because we should be under no illusion about what is happening in the Chamber today. The Secretary of State has said, in relation to this group of amendments and the Bill-it is effectively a one-clause Bill, because its substantive operation is in only one clause-that he wants to make social care one of the top three election messages. He did not say "priorities"; he used the word "messages".
	The Prime Minister announced the policy under discussion in his address to the Labour party conference, where it was cleared with only 20 minutes to spare. The policy goes utterly against the grain of the Government's Green Paper on social care, not least because it is being funded from general taxation. The impact assessment on costings covers only two and a half years, because the Government know that the expense will sky-rocket after that. It is perhaps some small consolation that the Government are behaving like a Government who may not be in office in the next Parliament.
	Nothing attests to the politics of the measure more than the fact that we are discussing it in a Committee of the whole House-a procedure normally limited to excessively controversial legislation, particularly legislation that is in free-vote territory. The Government are rushing the Bill through to prevent the fullest possible scrutiny. We will do our utmost to get through all the groups of amendments today, but I fear that that will be at the expense of the necessary wider scrutiny of the underlying issues of the policy behind the Bill. Another small consolation is that the fiercest attacks-certainly if the record to date is correct-will come from the Government's own side when the Bill continues its pell-mell progress in the other place.
	The Secretary of State has said that he wants to create an "unstoppable momentum" for reform of social care. This piecemeal measure, which affects around 270,000 people-not even 5 per cent. of social care users-has already put a spanner in the works of the Green Paper process, preventing the full publication of the costings, Ministers claim. Making the Bill work will put a spanner in the whole process of reform which, I fear, is the social care legacy the Secretary of State is aiming to leave. That comes on top of the point of order that I just raised with Mr. Speaker, prior to you, Sir Alan, taking the Chair for the Committee of the whole House. The impact assessment was prepared in a way that has not stood the test of time-even the weeks since the publication of the Bill.
	Amendment 9 would prevent care from being provided free of charge for more than six weeks to someone in any of the named institutions. It is deliberately a probing amendment, so that we can get to the bottom of the matter in the glare of the fullest scrutiny on the Floor of the House. I confess that we have had only smoke and mirrors from the Government on the matter.
	Amendment 10 simply defines a care home. The Northern Ireland proposal is not relevant, but why has the Minister gone for the convoluted phrase,
	"the provision of personal care to a person living in accommodation that an establishment provides to the person together with the care"
	rather than using a statutory definition that is already in force?

Stephen O'Brien: I am extremely grateful to my right hon. Friend, whose expertise and experience in this area are matched by none in the House and few outside it. We know the provenance of the Government's proposals as set forth in the Bill-we know that it was a rushed job, with only a 20-minute clearance time between decision and announcement at the Labour party conference-but even putting that to one side, he is quite right that it is vital to consider who is to be included. That question warrants proper scrutiny, because the fact that some people will be included means, by whatever definition is used, that the rest are excluded, and that will cause potential injustice.
	My right hon. Friend will find that in our discussions on later amendments, although I am conscious of how difficult it will be to remain in order, because things are so tightly drawn, not least the selection of amendments. That has been extremely constrained by the deliberately tight drafting by the Government of the money resolution, to try to exclude discussion on the much wider processes promised in the Green Paper and suggested by others, who have made some extremely interesting and sensible proposals in considering the reform of whole social care, rather than one small aspect of it, relative to the overall demand. I suspect that my right hon. Friend's concerns will be most clearly addressed when we come to an important discussion on compliance-how we ensure retained compliance with the European convention on human rights and the ability of the Secretary of State to issue the certificate under the Human Rights Act 1998, as stated on the front of the Bill. I very much hope that my right hon. Friend will have the opportunity to look at that aspect when we reach that point.
	Building on what my right hon. Friend has just helpfully mentioned, the Bill attempts to cut out residents of care homes from eligibility for free care. Last year, 50,000 people-yes, fortunate people, but also hard-working people who have done the right thing in investing, perhaps through a mortgage, in their own homes-had to sell their homes to pay for their long-term care, notwithstanding the fact that some sales did not occur until after people had died. That applied under a system that is available, but not often taken up, concerning whether people sell at the time they enter care or, indeed, when they leave it-under the home protection scheme or whatever.

Stephen Ladyman: I can probably find common cause with the hon. Member for Eddisbury (Mr. O'Brien) in certain respects. I understand his desire to probe the Government and secure greater clarity. As was observed by the right hon. Member for Charnwood (Mr. Dorrell), a former Secretary of State, it is plain that at some point the Government will have to go further. I see no moral justification for excluding a group of people with fairly serious care needs from Government help, whether they are in their own homes or in residential accommodation. At some point in the near future, we will require a personal care not at home Bill to address that need.
	I might part company from the hon. Member for Eddisbury on this point: he and his party have proposed the idea of a home protection system, under which, for a fee, the totality of a person's residential costs will be met. I believe that that would create a strange precedent, because for the first time an individual in this country would not be responsible for providing their own board and lodging. It has always been a principle that we are all responsible for providing our own board and lodging. Even if we have to pay for it out of benefits, that is still taken into account. The Opposition's solution to the problem would go against that principle.
	In probing the matter before us, the hon. Gentleman has set running some hares that perhaps need not be set running. I am particularly concerned about the fact that he is attempting to exclude extra care housing, because I believe that it is a model for the provision of care for older people in the future. Indeed, the huge majority of older people tell us they would aspire to such an arrangement were they to develop a care need because it means that they could live in their own accommodation.
	If the hon. Gentleman looks at the Department of Health website, he will find a clear definition of extra care housing, not least in the guidance for a competition in which developers were invited to bid for an £80 million fund to build extra care accommodation. One of the key elements of the definition is that the individual lives in their own home. They might have bought their extra care accommodation or be living in it as a tenant, but they will have security of tenure; they will have self-contained facilities so that they can cook and have access to their own bathroom and sanitary facilities; they will have their own front door which they can close to the world if they so wish, and they will be able to arrange their care needs themselves.
	The current system of means-testing people has the added advantage that, given that the accommodation will be the person's own home, the value of that home cannot be taken into account in the means test. The person might be looking to protect some of their savings, and that is a good way of preserving equity and passing it on to children-that might be important to them. I believe passionately, therefore, that extra care housing is a model that we need to promote. I believe that the Government have accepted that, and until we started debating the Personal Care at Home Bill and amendments to it, I always thought that the Opposition wanted to promote it as well. However, in the light of Second Reading and-on the face of it-amendment 9, I am now seriously worried about whether they understand the nature of extra care housing and its importance in the future.

Stephen Dorrell: The hon. Gentleman is entirely right, because of course the cost of even this limited pledge is significant in public expenditure terms and the Government have made it crystal clear that no additional money will be provided to local authorities to allow them to meet the additional burdens that this pledge imposes on them. Thus, it must be assumed that somebody, somewhere else, who benefits from local government expenditure-as he says, it is likely to be other people who benefit from social service expenditure-will pay for this pledge from the Prime Minister.
	As a result of the amendment tabled by my hon. Friend the Member for Eddisbury, I wish to focus on the implications of creating this distinction between the small group of people who will benefit because they receive "personal care at home" and the much larger group who will still have to pay for personal care under the old rules. What are the implications of creating that new distinction? I suggest that there are three such implications on which the Committee should focus.
	The first is the short-term implication. A group of people who change their care arrangements according to their requirements will suddenly find themselves taking decisions based on a major cost implication that ought to be taken based on their care need. There will be two categories: those who are at home, who get all their personal care free; and those who are defined as out of the "at home" category, who will still have to pay for their personal care according to the old rules. It therefore matters hugely who is "at home" and who is not "at home", and the amendment tabled by my hon. Friend the Member for Eddisbury is an attempt to define precisely who is not "at home".
	The former Minister, the hon. Member for South Thanet (Dr. Ladyman), reacted to my hon. Friend's amendment by saying, "Oh, these people who receive extra care ought to benefit from the pledge." Perhaps they ought to benefit from the pledge, but if they do, the cost will go up immeasurably from the £500-odd million that the Government say that it will already cost. My hon. Friend is drawing attention to the fact that the much larger group of people who do not receive personal care "at home" will be the losers from this prime ministerial election pledge.
	That is the first implication: where there is currently a logical development of care provision, in future there will be two categories and an anomaly created by the move from one category to the other. That is the first and immediate consequence. The second consequence, which is, in my view, much more malign, is that if this policy were to endure for any length of time, people would change their behaviour in order to ensure that they fell on the right side of the line to benefit from the pledge rather than on the wrong side of it.
	Let me pose a few questions to the House. If personal care at home is free, but personal care delivered not at home is not free, is somebody allowed to move their home in order to ensure that their personal arrangements move from one side of the line to the other? Members of this House have learned over the past 12 months the dangers of moving their house from one place to another in order to qualify under rules under which one did not previously qualify. If we create a group of people for whom personal care is free and say that it is available only to those who are at home, we should not be surprised if people who receive personal care and do not qualify immediately change their arrangements in order to ensure that they qualify. The definition of what constitutes "at home"-of who is included and who is excluded-will be the subject of constant challenge as people change their arrangements to ensure that they qualify, although they originally did not.
	I was reading the definition that the Government have offered of people who are excluded from the benefit of the pledge. Let me repeat it to the House. People are excluded if there is
	"the provision of personal care to a person living in accommodation that an establishment provides to the person together with the care".
	If I provide accommodation and personal care to my parents in my grannexe, will that be included or excluded? Is a grannexe where I or my family provide personal care to my elderly relative included or excluded? Is my grannexe an "establishment" according to the definition in this statute? It is unclear to me.

Norman Lamb: The right hon. Gentleman makes a very good point about the danger of a partial solution changing behaviour and having perverse consequences, but does he not agree that the Conservative proposal carries the same risk in that the pledge only relates to providing for the cost, through insurance, of care in residential homes? That is also a partial solution that would influence people's decisions.

Phil Hope: First, it is social care, not medical care, that is being provided. The hon. Gentleman's phraseology suggested that he was talking about medical care, and I want to make it clear that this is about personal care for people whose need is most critical and who need help with toileting, and so on. This is about intimate personal care.
	A number of guidelines and regulations are out for consultation, and they will need to be enacted when the Bill receives Royal Assent. People will qualify from 1 October this year. The process by which that will happen will also be the subject of guidance, to ensure a smooth transition as people who are currently in their own home and who qualify under the appropriate criteria start to qualify for free personal care. The provisions apply not only to new entrants; people who are currently living in their own home and paying for personal care because they failed the means test will now start to get their care for free. A further 130,000 will receive free reablement or rehabilitation to help them to recover their independence after a fall, a bereavement or a serious illness. I will say more about that when we discuss the later amendments.
	The Bill is based on the simple principle that we must do everything that we can to help people to live as well as they can and for as long as they can in their own home. That is what people tell us they want. This Government policy has been shared by both parties, at least since 1998 when the Griffiths report was produced. Indeed, the right hon. Member for Charnwood (Mr. Dorrell), when he was Secretary of State, supported the view that we should give as much support as possible to people in their own home, because that is what they want. I have listened to his remarks and those of his Front-Bench colleagues today, and I hope that that position has not changed. I hope that all parties in the House will support and respect the wishes of people-young adults as well as older people-to live in their own home.
	Amendment 9 would amend section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 so as specifically to list a number of settings in relation to which a six-week restriction on the ability of regulations to require provision of personal care for free would remain. The hon. Member for Eddisbury described it as a probing amendment, and I understand that, although I think that Labour Members listened quite carefully to ensure that that was the case and that the Conservatives' position had not changed.
	The list in amendment 9 is entirely inappropriate, as it includes some settings that are more appropriately described in the way that clause 1(2) describes them, and some settings that we would describe as falling within the notion of living at home-such as extra care housing, sheltered accommodation and warden-controlled accommodation, all of which are listed in the amendment.
	My hon. Friend the Member for South Thanet spoke from his experience as a Minister in this Department, and from his own professional experience, when he described the importance of extra care housing. I very much share his view. I listened carefully to the concern expressed by the hon. Gentleman that there might be game-playing among care home owners trying to change the status of their homes- [ Interruption. ] That was indeed mentioned on Second Reading; if I said this on Second Reading, I am certainly happy to put it on the record again.
	It is for the Care Quality Commission to register care homes and extra care housing. Only care homes that genuinely change the nature of the care they provide to create extra care housing would be registered as such. As my hon. Friend said, we do not need to write all that into the Bill, because we have a regulator to ensure that the kind of behaviour described by the hon. Gentleman would not happen. The right hon. Gentleman gave the example of granny annexes. People living in such accommodation would also qualify for free personal care because they are not in residential care accommodation.
	The Bill does not list all types of accommodation. Its provisions are straightforward. Apart from the one circumstance of adult placements-we will discuss an amendment on that later-we have excluded anybody in a residential care home from qualifying for free personal care. Everybody else is included by default because they are not excluded. That is how the Bill is designed. It is an elegant way-my hon. Friend described it as such-of achieving the policy goal that we want to achieve, which is to provide for and help people with the greatest possible needs who are living in their own homes.
	The right hon. Gentleman suggested that we have identified one group but ignored everybody else. The problem with his approach is that it would be a case of saying that we should either do everything or do nothing-that we should not introduce this extremely important measure to help people in the most need in their own homes. Why did we introduce a carers strategy? Why did we introduce a dementia strategy? Why did we introduce a strategy on valuing people with learning difficulties? We did those things because we are building on, improving and raising the quality of care step by step.
	The hon. Member for Poole (Mr. Syms) indicated, as he did on Second Reading, that he favours the Green Paper. I am delighted that I have a convert from the Conservative party. Indeed, many of his colleagues praised quite lavishly the Green Paper, which is being considered with a view to transforming the whole system. I am proud to be the Minister of State standing at this Dispatch Box leading on the proposal to create a national care service-how good can it get?-but that does not mean that I am going to stand still while I am waiting for that to happen; I want change now, as well. Step by step, the building blocks towards creating a national care service are being put in place, and this measure is a key part of that.
	Amendment 10, as an alternative to the approach that we are taking, would insert a definition of "care home" into the Bill. We regard that as unnecessary. The description that the Bill uses in amending section 15(4)(b) of the Community Care (Delayed Discharges etc.) Act 2003 is
	"accommodation that an establishment provides to the person together with the care".
	We do not propose to change that. The hon. Member for Eddisbury proposes in his probing amendment that we should use the definition in the Care Standards Act 2000, but that is not right in this context because it includes some exemptions and exceptions and therefore would not accurately reflect the range of settings that we want to exclude from free personal care. We think that our approach is the right way forward.
	In response to the hon. Member for North Norfolk (Norman Lamb), yes, direct payments would be a method of providing such free personal care if someone chose to go down that road. This is an important point about the very nature of the transformation of the care system. Increasingly, we want people to have more choice and more control over their care budgets, and direct payments are one way of doing that. Personal budgets, which are a development of that approach, are being rolled out across the country, with more than 100,000 individuals now receiving their care in that way, giving them choice and control. This is free care for the people in the most need. If they choose to have it through a direct payment or as a personal budget, that is absolutely the right thing to do. It will be up to local authorities to develop and implement this approach-that is what our extra £500 million for the transforming social care budget is all about. Some authorities are getting there quicker than others. I hope that the measure will provide an incentive for some of those authorities to start to develop their services in a way that we, and I hope the whole House, would like them to offer in taking forward their care provision.

Stephen O'Brien: The debate has been extremely helpful and constructive in bringing out precisely what the amendments were intended to probe and elucidate. It has been acknowledged that where the dividing line falls is an issue to consider, and that we need greater clarification. It is possible that as the Bill progresses through its next stages in the other place, their lordships may wish to take up some of our questions to get that clarification, but we have had a good exploration of the matter.
	As I said, these are probing amendments. I am glad that the hon. Member for South Thanet (Dr. Ladyman) felt reassured by the way in which I dealt with his concerns about whether there is mutual understanding on extra care communities and the home settings to which they relate. However, at one point he asserted that there was a principle that people do not get free board and lodging, as though that were somehow not to be challenged. That is not true either in a hospital setting or in many other settings. We need to be careful about announcing principles as though they were inviolate, when I am not sure that they stand a true examination.
	As was reflected in the comments of my right hon. Friend the Member for Charnwood (Mr. Dorrell) and others, it is important to recognise that despite some of the discussion that has taken place, we must not look at the matter as though it were simply about removing a six-week time limit and not changing any other circumstances. The hon. Gentleman gave the game away when he talked about certain circumstances, because circumstances have changed. The 2003 Act, which the Bill is intended to amend, addressed a different mischief that needed remedying-inappropriate bed blocking in hospital settings. This Bill is not about that, it is about doing something to support people in their own homes. It is not about removing people from one setting but about what they get in another, so the circumstances have changed. It was helpful that the Minister made that clear, but the way in which the matter was discussed at other times was not particularly appropriate. We need to be very careful, because the clause does not provide for some kind of simple removal of an element of a Venn diagram. It is definitional, because it deals with who can qualify. We even heard the Minister try to explain the understandably complicated matter of how on 1 October, if the Bill receives Royal Assent, the system will include both people who currently receive some care support, who may have to pay for it or may get it free, and others with different transitional arrangements. Later amendments will cover that matter.
	This discussion has helped set us off towards a greater understanding of the complications of how the Bill is drafted and the concept that lies behind it. More importantly, it has helped to ensure that we get as much clarity on the record as we possibly can. I beg to ask leave to withdraw the amendment.
	 Amendment, by leave, withdrawn.

Stephen O'Brien: Amendments 11 and 12 are intended to allow secondary legislation to stop the six-week restriction on free personal care. Amendment 12 is the operative amendment, upon which the House may wish to express its opinion depending on what the Government say. I flag up the fact that although it is not the lead amendment, it will be the appropriate one on which to divide if there is to be a Division.
	It is somewhat disingenuous of the Minister to suggest that the provision in question is the direction of travel of the Green Paper. It is in fact a fully taxpayer-funded option, which was previously rejected by the Government in explicit terms, not least by the Secretary of State and the present Minister, because the working population of this country is shrinking as a proportion of the total population. That has been discussed and is widely recognised both in this place and by many experts and advisers outside. I refer the Minister to the Secretary of State's reply when he was keenly questioned by Members of his own party below the gangway. He resisted their calls for taxpayer-funded options for social care, saying that it would not be
	"fair across the generations to ask the working age population to pay"
	for care. He continued by saying that
	"it would not be honest or straightforward to give the impression that we can fully fund a care system entirely from general taxation."-[ Official Report, 29 October 2009; Vol. 498, c. 479-81.]
	We agree, and that is part of the challenge in the Green Paper that we are all considering. However, this Bill proposes, for the class of people outlined in it, to provide an option for care fully funded by taxation. That is inconsonant, to put it one way, with the direction of the travel in the Green Paper, although some might call it disingenuous.
	The Minister confessed, in a parliamentary answer:
	"It is very important not to conflate the funding for a national care service with the funding for the Government's Personal Care at Home Bill. The Green Paper"-
	unlike this Bill-
	"is about building a sustainable system for the future".-[ Official Report, 5 January 2010; Vol. 503, c. 277W.]
	We all agree with that, but does it mean that the Minister is suggesting that this Bill is not sustainable for the future? Does he in fact agree with the point made by my right hon. Friend the Member for Charnwood (Mr. Dorrell) in the debate on the previous group of amendments that the Bill is a step along a path that may be distinguishable in legal terms, but will certainly be superseded in policy and legislation terms. That is a genuine question, and it is why we have included enabling powers in amendment 12.
	The Minister has also said in a parliamentary answer that the measure in the Bill
	"was not considered in the Green Paper"-
	that is a confession-
	"because it is a step towards that National Care Service. The Green Paper puts forward fundamental proposals".-[ Official Report, 9 December 2009; Vol. 502, c. 497W.]
	If this is not a fundamental proposal, does that mean that the Government plan it only as an interim measure?
	The best way for the Government to make earnest on their pledge that this Bill is a step towards the full reform of social care would be to make this Bill more enabling in terms of additional policy options. One of those could be our asset protection scheme, which would involve the option of paying £8,000 at age 65 by those who have sufficient assets. Those who do not have such assets would continue to be protected, and those who did not take up the option would be in no worse position than they are today. Those who did take up the option would be entitled to residential care for life, should it be necessary. Who is to say that similar schemes could not work alongside the Government's measure in domiciliary care? We are not precious about the scheme, and it would provide an opportunity to widen the Bill and bring in a much more comprehensive approach that would genuinely be consonant with the Green Paper, which was welcomed-and urged on the Government-by both sides of the House.

Stephen O'Brien: Aside from the enjoyable little tail to that question, which I am absolutely sure deserves a job, I have not confirmed whether amendment 12 is a probing amendment, because I genuinely wanted to test the opinion of the House. I am not suggesting that I will therefore press it to a Division; rather, I am seeking to test whether there is an opinion in the House that the way the Bill has been introduced fits well with the overall direction of travel. I dare say that there could have been a touch of irony in a debate on amendment 12-if  Hansard can record irony-because it might have revealed whether the hon. Gentleman was confident that a Labour Secretary of State would be exercising the powers, or whether he thought there would be a Conservative Secretary of State. However, I would not presume to take such powers on behalf of my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) if the electorate decided that he should be Secretary of State.
	The amendment seeks to test whether the House thinks it appropriate that we should be discussing the matter in a wider context. The hon. Member for Leeds, North-West (Greg Mulholland), who speaks for the Liberal Democrats, twice mentioned that the extreme tightness of the drafting in the money resolution, which is deliberate on the part of the Government-but that is how it is-has clearly made the selection of the amendments particularly tight and challenging. Amendment 12 has given us the opportunity to at least have a sense of getting that discussion moving. We will decide whether the House needs to give it a better airing once we have had our discussion.

Stephen O'Brien: The hon. Gentleman fully accepts, I think, that although the Secretary of State, in his current role, has made it clear that, as part of a legacy, or whatever he wishes to claim for it, he seeks an unstoppable momentum beyond the next election, our concern is that, strangely enough, the Bill is in danger of not creating that momentum. Indeed, it could do the opposite, because it is not consonant with the whole approach to the reform of social care that we hope the Green Paper process, which so many of us have bought into, will achieve.
	I fully accept that, ultimately, there is only one way forward, which is for the country, through its elected representatives across the House, to seek a genuinely broad consensus. We will never satisfy either those who think there should be a fully taxpayer-funded option or those who think we should have a complete free-for-all in the private market. The solution lies somewhere between the two. We have had that discussion with Government Members. We know that a number of them would not go along with what has been proposed, so reaching that point will be a tough challenge. That is why amendment 11 is important in clarifying the intent. However, I will wait to see how the Committee feels about the issue before I make a decision on whether to press the amendment to a vote, because I take seriously the idea that we need the best and most solid consensus that we can achieve.
	One thing that I should say-I see that the Minister is in discussion at the moment-is that it would be helpful in building that consensus if there were a genuine willingness on the part of the Government to start some discussions and to invite in those of us who wish to build that consensus. However, while we remain only in discussion across the Dispatch Box, which is necessarily a somewhat scrutinising and adversarial approach, we diminish our chance of achieving a consensus. However, that is perhaps the nature of the run-up to the election, with the tribalism now being displayed.

Laura Moffatt: I am listening carefully to the hon. Gentleman, but is he not trying to have it both ways? I would love to move directly to a National Care Service, as I hope many who have taken an interest in the Bill would too. However, I respect and understand the need for us to think carefully about the financial implications. Is he not giving the impression, particularly with amendment 12, of an open book for what could be achieved? By tabling that amendment, is he not giving the impression that something more could be delivered, when he knows that we are all under serious financial constraints?

Stephen O'Brien: I am grateful to the right hon. Gentleman, partly because what he suggests is relatively flattering. Luckily, however, I am enough of a realist to recognise that, nice as it may feel, it is not the same as being in government when the Opposition's probing or other amendments are probed in turn by Government Members. I can assure the right hon. Gentleman that there have, of course, been extensive internal discussions, as he would expect, within my party-as I dare say there have been within his party-on how to grapple with this particular issue.
	Those in charge of funding must be included. Why? Because, as I said before, there is probably no more predictable issue for the political generation coming down the track than this one. We know it is there; we all know it is pretty insuperable, but we have got to find a solution. None are more challenged than this generation of politicians in this House-either this side of the general election or after it when some may be re-elected-in facing up to this particular challenge. The right hon. Gentleman is rightly probing me on why I tabled certain amendments, but I am very conscious that we have had a series of discussions and open inquiries, not least the one led by my right hon. Friend the Member for Charnwood shortly after my right hon. Friend the Member for Witney (Mr. Cameron) became the leader of the Conservative party. It looked into these very issues, so my right hon. Friend the Member for Charnwood has been able to advise us accordingly. That has led, in turn, to many discussions among and across many shadow departmental briefs.
	I hope that that gives the right hon. Gentleman the reassurance that he sought-that this matter is taken extremely seriously, as the issue betokens. If our generation ducks this one, we will be in grave danger. My plea to the Minister is, as I have said repeatedly from the Front Bench, that there could be a way to gain a better and more consensual approach, given that we are all in this together. At the moment, this has fallen somewhat flat, as the Minister has not formally invited me or Liberal Democrat Front-Bench Members to have a consensual chat about these matters. I would be very happy to participate in that, even if it were completely off the record, not least because there is a precedent-this relates partly to the amendment-for something along these lines in respect of pensions. There has been a greater degree of consensus on how to find a way forward on that subject, which was also a challenge for us and will be for those coming down the track. It is important to place that on the record in the light of the quite proper rejoinder of the right hon. Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), who wanted to probe my amendment; whether or not it is a probing amendment has yet to be decided.
	It is important to bear in mind the fact that the Bill amends the Community Care (Delayed Discharges etc.) Act 2003, whose purpose was to deal with what could have been described in legal terms as the mischief of bed blocking. Section 15 removed the limit at which care could be provided free of charge. I assume, although it may not be the case, that even if someone joined the social insurance risk pool mentioned by my hon. Friend the Member for Poole-the Government's Green Paper partnership option, for instance, is still very much under consideration-that would not count as a charge, in which case the Bill could make such a model possible. Given that Tony Blair promised reform 12 years ago, would it not be best for us to produce a consensus to make full reform of social care possible through the Bill? The amendment was intended to give us a genuine opportunity to consider that question.

The Chairman: Before I call the next speaker, let me point out that although there are clearly serious matters at the heart of this debate, I have allowed some tolerance of the wider conceptual debate. However, I am not sure that we would be best served by the inclusion of a wider conceptual debate on every group of amendments, and I shall be paying attention in that regard.

Stephen Ladyman: I think there is some common ground between the hon. Member for Eddisbury and me. I agree that this measure must, at some point in the future, be swept into a more comprehensive and consensual package. I also believe that that comprehensive package must include some sort of asset protection scheme for those who go into residential accommodation, although I do not favour the scheme suggested by the Conservatives.
	The hon. Gentleman said that the Bill had been dreamt up by the Prime Minister at short notice and cleared in time for a conference speech. I do not know whether that is true, but I do know that the Conservatives' response in the shape of their proposed asset protection plan was dreamt up in the seven days following the Prime Minister's speech, in time for their own party conference.

Stephen O'Brien: I am happy to put on record that some of us had been working on it for about three years. We were very glad to note that there just happened to be decent timing for its announcement.

Greg Mulholland: I do not think that anyone could disagree with what has been said by the hon. Member for South Thanet (Dr. Ladyman) and, indeed, the hon. Member for Eddisbury (Mr. O'Brien) about the need for a consensus. All along, much of the concern about the Bill has been that it is a partial solution which will help only a small number of people. We can, however, disagree on whether that would be a good step forward or unhelpful. There are different views on that.
	On amendment 12, however, I too listened to the hon. Member for Eddisbury, and I do not think that any of us could have disagreed with the vast majority of the sentiments that he expressed, in his usual eloquent, if rather lengthy, way. Nevertheless, we should consider his speech in the context of the amendment. It reads:
	"to such other arrangements for the provision of personal care as the Secretary of State may, by regulations, specify."
	I cannot see how that relates to the sentiments in his speech.
	The concern of Liberal Democrat Members is that the Bill is a partial solution and not a part of the existing consensus. The Bill came in the middle of the consultation on the Green Paper, and I even wonder whether those involved in the consultation and in drafting the Green Paper had any idea that a Bill was coming when it was announced out of the blue by the Prime Minister. The Bill came in through the side door, but the hon. Gentleman's amendment would give the Secretary of State the opportunity to bring in anything via the back door. That would be even more regrettable and take us further away from achieving a cross-party consensus, which is precisely what we need if we are serious about moving the debate forward. If the hon. Gentleman presses amendment 12 to a vote, therefore, we will not support it.

Stephen Dorrell: I invite the hon. Gentleman simply to consider the point that I have just made: what will be the consequences of each incremental step that he is inviting us to take? If he agrees with me that the consequence of this policy formulation is to create an incentive in favour of residential care rather than care at home, for the reasons that I have set out, and if he agrees that in the long run we must provide a funding base for social care that includes co-payment, all I would say to him is that if, perchance, there were a Labour Government after the election-I profoundly hope that there is not-and if he were a Minister in it, I would look forward to hearing him make a speech from the Dispatch Box that explained to the House why it was a good idea to have free personal care ahead of the election whereas after the election that would evolve into a system of payment through co-funding for personal care delivered at home. That is the policy that I believe that he supported until the Prime Minister made his statement at the Labour party conference, and I believe that any incoming Labour Government would have to revert to it after the election-perhaps even before October 2010.

Stephen O'Brien: I am grateful to my hon. Friend for giving way. In the light of the contributions made by him and others, and in advance of the Minister's remarks in reply, it might be helpful for me to confirm that this is, in fact, a probing amendment and not one that will be forced to a Division. I believe that the amendment has led to an extremely helpful discussion, and I hope that what I have just said has changed the tenor of the debate on this particular group of amendments.

Robert Syms: That is useful information, although I may call the vote myself.
	I think that amendment 12 is useful, not least because it gives the Minister the opportunity to set out what the Government are going to do in a little more detail, and because it looks forward from where we are today to the big bang approach in October. It is very important that more information is put in the public domain. The scheme's shape and funding must be made clear to local authorities. Its success or failure will not rest on whether Whitehall pulls a lever, but on lots of hard-working people in local authorities around the country being able to support and implement it in the way that the Government intend.

Phil Hope: We have had an interesting debate on this amendment. My hon. Friend the Member for South Thanet (Dr. Ladyman) described it as an "open ended carte blanche free hand to redesign the whole of the personal care system by diktat"-what a temptation that possibility offers! It is very strong, but unfortunately I am unable to support this probing amendment.
	A number of important points were made in the debate. In moving the amendment, the hon. Member for Eddisbury (Mr. O'Brien) once again challenged the extent to which the Bill and its proposals for free personal care for people at home with the greatest care needs were congruent with the Government's thinking on developing a national care service. I am absolutely convinced that it is a step along that path, as I said in the debate on the previous series of amendment. I set out then everything that we had done over the past 12 or 18 months to develop and improve this country's social care system, and I think that this proposal is simply another feature of that.
	The amendment would allow a future Conservative to introduce changes to the care system, but the remarks made by the hon. Member for Eddisbury let the cat out of the bag. From what the right hon. Member for Charnwood (Mr. Dorrell) said, it is clear that the Conservatives see what the Government are trying to do as a perverse incentive and an anomaly. I cannot think why the right hon. Gentleman would want to put out a leaflet with his name on it in my constituency, saying that providing free personal care was an anomaly, and perverse.
	I shall have to check Hansard to make sure that I wrote this down correctly, but the hon. Member for Eddisbury said, "We do not want to encourage a policy of free personal care for people in their own home. This is not the direction of travel of Conservative policy." It is interesting that the amendment has flushed out what I think is the true intent behind the Conservative position on these matters.

Phil Hope: We are, of course, seeking to develop our proposals for the creation of a national care service. We are building on the best practice that I know goes on up and down the country. That includes things like greater integration of the health and social care systems or, as we discussed earlier, making sure that people get direct payments, because we believe that personal budgets give people more choice in and control over their care.
	In developing our thinking for the future White Paper, we are looking at all the options, just as we did with the Green Paper consultation. We will also look at ways to take those options forward.
	It is true that there are problems with funding the whole of the care system in full through the tax paid by people of a younger age. I have made that point before in this House: the hon. Member for Eddisbury has repeated my remarks, and I am happy to repeat them again in this debate.
	There has been a demographic change in our population. Where there used to be four people of working age to one elderly person, over the next few years that will become only two. It will simply not be sustainable to maintain a system of care provision by taxing those people, but we will bring forward our solution to that problem when we set out our proposals for a national care service.
	In the meantime, I am not prepared to stand by and see people in their own homes with the highest level of care needs-and people at the critical level need help with four activities of daily living-having to run down their savings and drawing on the help of loved ones to pay for the support that they need.
	That is why the Bill is important, and I am disappointed that the Opposition do not seem to support what it proposes. I am also disappointed that the Liberal Democrats have decided to drop their pledge to provide free personal care for older people.

Phil Hope: We will have to have that debate when we bring forward our proposals for a national care service. The questions will be to do with how we take those proposals forward, and what is a fair, affordable and simple system for providing better care for people, both in their own homes and in residential institutions as well. That is a debate that we will initiate in the near future, and I am looking forward to having it.
	The right hon. Member for Charnwood said that our proposals were anomalous and acted as a perverse incentive, but when I challenged him he was unable to defend the home protection scheme that the hon. Member for Eddisbury proposed. That proposal is a private insurance scheme which, to protect a person's home-hence its name-covers only residential care. The costs are paid up front, although people need to have £8,000 to be able to afford it. It is optional-in other words, not everyone will take part in it-and partial. I have no doubt that it will exclude people with any underlying health condition, as they would not be able to get such insurance for the price £8,000.
	The hon. Member for Eddisbury is going to struggle to sell his home protection scheme, because it would merely provide a small amount of support for a minority group of wealthy people. If he thinks that that will win him the next general, he has another think coming.

Tom Clarke: This has been an interesting debate. I want, if I may, to focus on the aspects that have dealt with the role of local authorities, with particular reference to amendments 13 and 16.
	If the hon. Member for Eddisbury (Mr. O'Brien) had the same objectives as my hon. Friend the Member for South Thanet (Dr. Ladyman), I might even be convinced myself by the argument on continuing care, but I have to say, in all candour, that I am not. What we have established here today, perhaps not for the first time, is the existence of a big difference between the Conservatives and Labour in terms of how Governments work with local authorities. I cannot envisage a situation in which, in the absence of joint planning between local authorities and the NHS, we can deliver the kind of personal care that we have all agreed on.
	In relation to amendments 13 and 16, I am afraid that I must be even more ungenerous to the hon. Member for Eddisbury. Amendment 13 seeks to limit the discretion of local authorities in setting eligibility criteria for free care. The Conservatives frequently condemn direction from Whitehall and extol the virtues of localism and local control, yet they then table amendments to a Bill that would remove local freedom. I am not at all persuaded by that approach. I think that this is an essential argument about what sort of democracy we want to live in. Given that day after day, week after week, we meet councillors, directors of social services and others who have to implement our decisions, we should be a bit clearer than these amendments suggest about the very important role that local authorities play.
	Amendment 16 seeks to exempt local authorities from providing free personal care for those in a state of continuing care. If we spell that out, it means, in effect, extended care for a person over 18 to meet physical and mental health needs that have arisen as a result of disability, accident or illness. The amendment is difficult to understand if we take the view that we are to have a relationship between central Government and those responsible for delivery. I have never accepted that local authorities should see themselves as enablers rather than providers, which the hon. Member for Eddisbury hinted at. There will always be a case for both things on the part of central Government and on the part of local government, and that should be recognised.
	The amendment would exempt a section of the most vulnerable people from receiving free personal care at home because they are in receipt of continuing NHS care. I ask this question: why? I have not heard a convincing argument for it. If highly vulnerable people were to be treated in this way, significant costs to pay for care at home would arise. They should be entitled to the same support as everyone else in that group. The fact that they are receiving additional care from other sources such as the NHS should not take away the relevance of addressing their problem, having proper assessments, having a greater degree of advocacy than we have managed to discuss today, and delivering to those who need it the personal care that I believe is so essential.

Paul Murphy: I want briefly to follow my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke) by speaking to new clause 5, for which I have some sympathy, in relation to the portability of care packages.
	I should like to talk about the extent of the Bill in so far as local authorities are concerned. Presumably, we are referring to English local authorities, not to Welsh ones, although the Bill extends to England and to Wales. I am slightly troubled about the view that the National Care Service that we are rightly discussing will be universal throughout the United Kingdom. I would not dream of talking about Scotland; however, in terms of the Bill's application to Wales, I am not yet convinced that there has been sufficient dialogue between Welsh local authorities and the Welsh Assembly Government about how this might operate. I believe that the Welsh Assembly Government would be very agreeable to the principles of this excellent Bill, and indeed some of its details. I hope that my hon. Friend the Minister can give me an assurance that proper discussions are taking place between Welsh local authorities, the Minister for Health and Social Services in the Welsh Assembly and, indeed, the Welsh Local Government Association about the parts of the Bill that impinge on the duties and activities of English local authorities.
	In relation to the portability of care packages between English local authorities, there is a tremendous amount of movement across the English-Welsh border. Many people would find themselves in the same position as if they were to move from Derbyshire into Lancashire, as opposed to going back and forth into Wales from Gloucestershire or Merseyside. There are genuine cross-border issues, but also a worry that while benefits are UK-wide, the detail of local authority involvement in this package is for England only.

Stephen O'Brien: I am most grateful to the right hon. Gentleman for allowing me to intervene. He is making a very important point that is, to some degree, covered in amendment 28; if we are fortunate enough to reach it, he might want to take the opportunity to explore this a bit further. I endorse some of what he says, speaking as a constituency representative with a Welsh border, where there are many incidents involving people travelling across the River Dee to access some form of health service, continuing care, social care or acute services. That is causing a pretty big nightmare for all those of us concerned.

Stephen O'Brien: The purpose of amendment 15 is to probe again the £250 million efficiency savings on which this Bill depends. Can the Minister tell the Committee how he has calculated that figure? We worry that, as the impact assessment suggests, he has just plucked that figure out of the air.
	Amendment 48 would give the Secretary of State flexibility to limit the cost to local authorities. The question is who is exposed if the Government have got their calculations wrong? Would it be the Treasury or local authorities? Should the Exchequer-the national taxpayer-bear the costs of any mistakes or should it be local taxpayers or even the recipients of care services?
	The Local Government Association, in its briefing on the Bill, expressed its concern that the Government are not confident about the accuracy of their cost estimates. Many councils have already planned their savings and budgets for the year that the policy will start-2010-11. Councillor Ken Thornber, the leader of Hampshire county council-with West Sussex and Kent, it is one of the Conservative-controlled councils giving a good lead on social care-has said that his council would have to find between £5 million and £10 million above present projections.
	This morning, I received a letter from the chair of the Learning Disability Coalition, Anthea Cox, which stated:
	"We remain extremely concerned at what the implications for local authorities will be in terms of finding £250 million a year from efficiency savings. We are most anxious that these savings do not mean cuts in services for other needy people. It makes no sense to direct extra funding towards people who have their own significant resources as increasing the numbers of people who will become eligible for personal care funding at the highest level of need will reduce the funding available for those with substantial levels of need. There is considerable anxiety where the cuts may be made and the impression that care is being rationed for people with moderate needs. If an outcome of the Bill is further pressure on social care budgets this could well lead to further rationing."
	The blunt truth is that if these savings cannot be found from the efficiencies somewhat loftily urged by the Government-but with no specific plan for achieving a penny piece of them-they will have to come from cuts or increases in charges. The biggest concern is that increases in charges will fall on those with substantial, moderate or low care needs. I asked the Minister in a written question whether charges are likely to be raised. He replied:
	"Setting charges for social care is a matter for local authorities."-[ Official Report, 10 December 2009; Vol. 502, c. 553W.]
	That does not provide much clarification.
	There are equally serious questions about the £420 million central funding. Thus far, the Minister has confirmed that he will cut £50 million from public health campaigns, £60 million from management consultancy, £20 million from administrations costs-that is easy to say, but I wonder whether it will be his Administration-and £62 million from research into cancer, dementia and other debilitating diseases. That is worrying given his recent claim that he is seeking to match our promise to increase research into dementia because of demographic changes and the profile of disease occurrence. Those savings add up to only £192 million, so I ask the Minister where the rest will come from.
	Can the Minister explain why the summary of the impact assessment says that the annual enforcement cost of the policy is not applicable, but in a written answer to me on 14 December 2009 he said that it is estimated to be £27 million? How did he make that estimate? Are the illustrative grant allocations weighted, or are they simply produced according to the probable numbers in receipt of care at the critical level? How will the formula work?
	What will the Government do to upskill and, if necessary, grow the work force to meet the demands of this measure to bring care to an extra 100,000 people? That is not strictly a local authority cost, but it will be a local cost. The Royal College of Nursing is
	"very concerned about the impact that these reforms will have on the nursing workforce."
	It claims:
	"These changes will affect the workloads of health visitors, community nurses and specialist nurses-professionals who are already overstretched. The community nurse workforce, in particular, is ageing, with many due to retire in the next 10 years. With only 10 months until these measures come into force the RCN is concerned that there may simply not be sufficient numbers of properly trained social care and nursing staff to deliver the commitment to free personal care in the Bill."
	Does the Minister plan the substantial investment in community nursing that will be necessary if these changes are to be successful? Has he found a source for the funding required?

Greg Mulholland: In many ways these amendments go to the heart of the Bill and its core problems. The Prime Minister announced the policy at the Labour party conference-we all have our views on why it was announced at that time and in that way. The Government announced the shiny, new policy and then said that they would fund only part of it, with the rest of the cost falling on local authorities that are already obliged to find huge efficiency savings-3 per cent. this year, rising to 4 per cent. next year. That is unacceptable, especially given how this policy was introduced. It is supposed to be implemented from October this year, but most councils have already set their budgets for 2010-11. All the savings that they have identified have already been earmarked.
	The impact assessment has been roundly criticised, but the phrase that strikes most fear into those concerned about this area of policy is "inherent uncertainty", which is used about the costs of the implementation of this Bill. Simply to proceed on that basis, and to give an open-ended commitment to local authorities, which is precisely what the Bill will do, is entirely unacceptable. If the Government want to press forward with that policy, they are entitled to do so and to justify that. However, surely they should at least restrict the total contribution that must be made by local authorities, so that they can budget sensibly, as the Government rightly suggest they must.
	There are other implications. The UK Home Care Association has raised concerns that the measure will put a downward pressure on prices paid to independent sector providers, which provide 81 per cent. of publically funded home care, and that home care will be seen as a low-cost option compared with residential care. There is a danger that we would see a further deterioration in wages in the home care sector as a result of local authority pressure. There is already a huge turnover of staff in the care home sector-the rate is nearly a quarter. That is not good for the kind of care for older people that we would like.
	The message from the home care sector-this is from UKHCA's very good briefing-is simply that
	"there are no more pips to squeak"
	out of it to meet that kind of shortfall. If the hon. Member for Eddisbury (Mr. O'Brien) pressed amendment 48 to a Division, the Liberal Democrats would support him. We all accept that we are in a difficult time of recession, but should the Government say, "We expect that large contribution of £250 million from local authorities, but we are not going to expect more"? Simply put, it seems that the sums in the impact assessment cannot be relied on, and therefore, if the measure goes through, local authorities can expect it to cost them significantly more than the Government's estimate.

Stephen O'Brien: Amendments 31 and 27 stand in my name, while the Liberal Democrats spokesman, the hon. Member for Leeds, North-West (Greg Mulholland), will no doubt speak to his amendment 45.
	This is an important group of amendments, and the Minister will understand why. Amendment 31 seeks for a report to be presented to Parliament on the human rights compatibility of the Bill, reflecting the apparently shaky legal ground that the Government are on. Amendment 27 seeks a similar report into costs. To some degree, my anxiety to press that amendment to a vote might have been ameliorated by the Minister's most recent comments, in his response to the previous group of amendments, about the fact that there would be a review of the costs, including the members' costs and so forth, at quite a fine-grained level over, I think he said, 18 months or two years. That is obviously important in ensuring fairness in the system, as well as the clarity that will be needed.
	That said, uniquely, the impact assessment looks at costs for only two and a half years, so if we did not have a review within 18 months or two years, we would get pretty short shrift. The impact assessments that this Government have produced with Bills have habitually looked at costs over a 10-year period, so to get only two and a half years on a policy area covering such obviously long-term projections as this one does seems mighty unusual, if not a touch opportunistic. The costings are therefore somewhat shaky to say the least. I was therefore pleased that the Minister was able to set out at least some clarifications, corrections and admissions of error in his letter to the shadow Health Secretary, my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), on 8 January.
	Amendment 45, standing in the name of the Liberal Democrats, seeks a report on the numbers. It is amazing to find out that the Government have very little of the hard data on which their policy is based.
	On amendment 31, the Bill comes with a lengthy justification, by comparison with other Bills, of its rectitude in the face of the Human Rights Act 1998. Its length should alert the House to the Government's nimble footwork in the face of their own legislation. The Government's problem is that the Human Rights Act prevents discrimination on the basis of residence. The Secretary of State and the Minister's argument is that such discrimination is allowed in certain cases and that the Government have the latitude to discriminate in that way. So much for us all being equal under the law. It was that very discrimination that my right hon. Friend the Member for Charnwood (Mr. Dorrell) sought to highlight in one of his earliest contribution today. I therefore hope that he will have the opportunity that he was looking for to discuss the issue in our debate on this group of amendments.
	I am pleased that the Joint Committee on Human Rights is looking into the matter. I hope that that process will be concluded before the Bill goes to the other place, because it really needs to be. Through you, Mrs. Heal, I hope that some urgings might be made in the right direction, in order to speed up the Joint Committee's work, because of the speed with which we are considering the Bill in this House-I dare say that the Government will wish to push for the same in the other place-and because there is already an absence of the accompanying guidelines and regulations, either in draft form or actually published, that are so important for the Bill. The fact that we do not have the Joint Committee's report in advance, as is normally expected, makes us worried that there could be an attempt being made-I put it no more strongly than that-at a sleight of hand.

Stephen O'Brien: I will expand slightly on that point as I proceed, because it is a bit fine-grained and quite technical. However, in essence, his concern is confirmed, I am sad to say, in that there is effectively a get-out in such circumstances, by and behalf of Governments. That is highly challengeable, and therefore causes me concern; hence our amendment, which would require a report. The Committee would welcome that, given the importance that the whole House attaches to what appears on the front of Bills, namely a certificate, as required under the Human Rights Act, from the Secretary of State in presenting a Bill on First Reading to assure the House that it is compliant with the European convention on human rights. This Bill carries such a certificate, from the current Secretary of State.
	Given the numerous legal loopholes in the Bill, the Committee will be interested to know that, according to the Minister in a parliamentary answer to me,
	"No external legal advice was sought on this matter."-[ Official Report, 8 December 2009; Vol. 502, c. 293W.]
	We know that the Government are concerned, and not just because of the extraordinary length and somewhat defensive nature of the note in the explanatory memorandum, to which my right hon. Friend might find it helpful to refer. That concern is now being picked up elsewhere, not least by a commission by which the Government have set great store-indeed, they brought it into existence precisely to look into such questions. The Equality and Human Rights Commission has expressed concern that
	"this proposal appears to cut across the options set out in the Government's Social Care Green Paper."
	The commission also says:
	"Care must be taken to avoid creating negative trade-offs for other people still with considerable needs trying to access care at home. For instance, if the proposal actually further reduces the sums available to help those with less critical needs, but who could benefit substantially, including helping them to retain work or remain socially active, it may just serve to increase those whose needs more rapidly become critical."
	The Equality and Human Rights Commission said that in its briefing that arrived only at lunchtime today. I hope that that is regarded as useful information for the Committee to consider.
	I hope that the Minister will take this opportunity to confirm that the strength of any defence in a court of law would depend on the purpose of the Bill. In the compliance statement, the purpose of the Bill is about
	"enabling, supporting and encouraging more people to avoid or delay entering residential accommodation".
	The Government claim that that is a "legitimate aim" for the purposes of the European convention on human rights. However, according to the impact assessment, the purpose of the Bill is about
	"Funding care to those in need at the time of their need,"
	which is also what the Prime Minister said at his party conference. Is that a "legitimate aim" for the purposes of the Human Rights Act? The record will no doubt show the Minister's response, which will undoubtedly be prayed in aid by highly paid human rights lawyers. I dare say that he will have taken a lot of advice before making his prepared remarks.
	The Government's defence is also that the proposal is a "proportionate" measure, which goes some way to answering my right hon. Friend's question. What is the legal status of that defence, given that the Bill has such a small benefit for costs-if any, as has been accepted-that, according to the impact assessment, it has little overall effect on public sector manpower and public expenditure, and that it helps no more than 5 per cent. of the so-called at-risk population?
	The Committee will be interested to know that there is no statutory definition of the word "home", although it appears in a number of statutes, such as the Housing Act 1985. That was the Act that legislated for the right to buy, a right that has seen people gain property, as well as the social mobility attached to that, only to have to sell it to pay for their long-term care. Part of the problem that we are now facing is with precisely that generation. The 1985 Act speaks of a person's "only or principal home". There have been many cases concerning the definition of that phrase. I will not take up too much of the Committee's time, but hon. Members should be aware of the succession of cases on that issue, which include Crawley Borough Council  v. Sawyer in 1988, Ujima Housing Association  v. Ansah in 1998, Amoah  v. Barking and Dagenham in 2001, which will be of interest, and Hammersmith and Fulham  v. Clarke in 2001.
	That is an important succession of cases, because many of them link home with the intention of the resident to occupy it rather than with the occupation itself-so intent appears to be what the law relies upon. What happens in law if an individual is able to define the care home in which they reside as their home? The money resolution, as we know, if not the legislation per se, would make provision for the funding of that person's care. By proving that a residential care home is their home, could an individual make themselves eligible for free personal care?
	If the Minister does not have a ready answer, he can be fairly sure that the courts will seek to provide one in the due light of day if the Bill becomes an Act. I hope he will take this opportunity to guarantee that the Bill will not be open to legal challenge on human rights grounds. Is he confident enough to commit the Government to funding the full costs of any successful legal challenge on those grounds? Moreover, will he place the internal legal advice in the Library, given the germane points that have now been raised as a result of great concern, not least admitted by the fact that the explanatory memorandum has had to go to such lengths without the decisiveness of conclusion that one would normally look for with such an important matter as supporting a Secretary of State's certificate on the front of a Bill?
	This is not merely a case of lawyers dancing on the head of a pin, which some might argue is the closest to angels they will ever get. Professor Malcolm Johnson of the university of Bath has said that for people with high needs-those requiring care for more than 30 hours a week and typically dementia patients-more complete, appropriate and cost-effective care can be delivered in a care home. That is backed up, according to the noble Lords Joffe and Lipsey in the other place, not least by the Personal Social Services Research Unit-known as PSSRU-and the London School of Economics, which is doing the costings for the Government's social care models.
	In a response to me of 8 December, the Minister said that residential care would remain an "appropriate setting" in which to meet some people's care needs. If, because of financial concerns, the measure keeps people at home who really ought to be in residential care, it could be seriously detrimental to the mental and physical health of many frail people. That is why all the third parties are arrayed against piecemeal reform in this area. To some degree, there has been a certain circularity in the arguments over previous groups of amendments, not least in discussions with the hon. Member for South Thanet (Dr. Ladyman).
	Amendment 27 deals with costings. I repeat my rather lukewarm welcome, given the Minister's assertions at the end of the debate on the previous amendment grouping, but it is important to state from the outset and on the record that this care is not free. Someone must pay for it: in the short term that will be the beneficiaries of public health campaigns, and, it has been argued, the taxpayer and Cancer Research in the long term. We heard the rebuttals that the Minister sought to pray in aid at the end of the previous grouping, so we must take them as they were put forward, but someone somewhere has to pay. The proper phrase that should be used is "free of charge", but I dare say that that would spoil the Prime Minister's election leaflet's already printed slogan.
	As we have said, the Secretary of State has rejected taxpayer funding for social care reform, but the Prime Minister thinks it is a good idea. It is right to have some public services, like our NHS, that are free of charge, but we should never forget that they are not completely free. Indeed, it was the current Secretary of State himself who recommended that patients be given an indicative receipt for the cost of their care. I am sure that the Minister is more than well aware of the record of when the Secretary of State said just that when he was a Minister. The problem with Labour is that they continue to think of taxpayers' money as Government money. Increasingly, with their party facing financial as well as, one hopes, electoral bankruptcy, we should be concerned that they do not look to taxpayers' money as some form of re-election fund.
	The Government have estimated the cost of the measure as £670 million a year. "Estimated" is the right word. Table 2 is dependent on figures drawn from the unpublished modelling for the Green Paper, and the full model remains unpublished. The model used to estimate the flows in and out of residential care has not been published. The model referred to in paragraphs 5.12, 5.13 and annex B of the impact assessment is still under development. This is also the model on which estimates of savings are predicated. According to paragraph 4.6, the costs of the whole policy are still being modelled and the assumptions are going to be tested through consultation with stakeholders, which runs until 23 February. We have already discussed that point about the timetabling.
	The number of individuals who are FACS-critical critical is estimated from a secondary analysis of data from the English Longitudinal Study of Ageing-an analysis that has not yet been published. Little is known about the number of younger adults who fund their own home care. The figure of 110,000 should be "treated as an estimate", as I was told in a written answer.
	The estimate of people for whom reablement is successful is based on the experience of a single local authority, West Berkshire. The Minister has told me in another written answer that the Department does not hold equivalent data for other councils. Perhaps he would like to spell out the reasons why the Government feel that West Berkshire is representative of Britain as a whole.
	The estimate of home care spend in annex B of the impact assessment is an estimate plucked out of the air, for which the Minister has given no justification, while the estimate of the costs of reablement are also plucked out of the air. When I asked the Minister what the minimum and maximum costs of reablement were, he replied that he understood that there was a "wide variability" in "different councils" and that the "derivation" of a cost of £1,000 was "clearly stated" in annex B of the impact assessment. What does annex B say? It says:
	"It has been estimated that reablement costs £1000 a person (roughly 30 hours of reablement at £30 an hour)",
	but we have no sources for where either of those figures referring to the number 30 came from, so we have to ask whether these have just been made up. The costings assume that only 10 per cent. of the people who currently go into residential care will instead stay in their home to receive free personal care. Is that really tenable-that faced with the choice of paying £25,000 a year in a care home, or free care in their own home, only one in 10 will take up the free option?
	The Government have persistently refused to extrapolate their calculations beyond 2012, so we have had to do it ourselves. Using just a linear projection, the costs will double to about £1.2 billion a year by the end of the next decade. The excuse given to me in a parliamentary answers was:
	"We cannot reasonably make these extrapolations because of the levels of uncertainty",
	including
	"the unknown detail of any future national care service and the unknown future economic climate"-[ Official Report, 16 December 2009; Vol. 502, c. 1323W.]
	He also mentioned an uncertainty that aspects of people's behaviour would change as a result of the "introduction of these proposals", and that the policy would be reviewed after 12 to 18 months to "ensure" that there are "no perverse incentives". This is a funny way of doing policy: to set the hare running and if it all goes wrong, we will revisit it-a kind of microcosm of the last 12 years, one might suggest.
	Such uncertainties are eye-watering. For example, if all the people with informal care switch, this adds £17 million to the cost. If the Government have underestimated the number of younger adults with needs by just 10,000 across the country, it adds £6 million. If care inflation rises faster than general inflation-at 4 per cent., for example-this would add £14 million. An arbitrary underestimate of numbers of elderly people of just 1 per cent. adds an extra £5 million. The assumption that the relationship between care need and cost is linear-in annex A-turns out to be wrong. Again, a 1 per cent. deviation equals £6 million extra. If all these costs were realised, it would cost an extra £49 million a year. If the Bill provides a perverse incentive for care homes to redesign themselves as "extra care"-we have had some discussion about that-and that happened, it would add an extra £1 billion to the cost. Even if only 10 per cent. did so, it would still be another £100 million.
	My estimates are, perhaps naturally, pretty conservative. The noble Lords Lipsey and Joffe, in their supplementary memorandum to the Green Paper, were highly critical of this measure, noting that the costs in Scotland inflated by 74 per cent.-that was equivalent to an extra £500 million in the first year. Leaving aside the potential costs of the measure, given that people will not receive transport, meals, cleaning, shopping, sitting services and so forth free of charge, will the Minister tell us the likely range of spend on such services for an individual receiving what the Government are now proclaiming as free care? On that basis, I support amendments 31 and 27, and point out that we may well wish to divide the Committee.

Stephen Dorrell: I congratulate my hon. Friend the Member for Eddisbury (Mr. O'Brien) on tabling the amendments and again on the way in which he spoke to them. Both amendments are hugely important.
	Amendment 31 deals with the European convention on human rights. My hon. Friend should be specifically congratulated on reminding the House that the modern world is increasingly one in which the untrammelled right of law-makers to make laws that seem like a good idea on their way to the party conference podium is qualified by a series of commitments that Governments have entered into over the years to ensure that the laws of this country comply with certain basic principles. For our present purpose, the principles are set out in the European convention on human rights. According to one of them-acknowledged in the explanatory notes-it is not consistent with the convention, and therefore with good law, to discriminate between individuals on the basis of where they live. First, the Government acknowledge that that is a principle of good law because it is in the convention, to which this country is a signatory. Secondly, the explanatory notes explicitly recognise that an individual in residential care
	"might allege that they are being discriminated against in the protection of their rights under Article 14 ECHR".
	This is not something dreamt up by my hon. Friend; it is something that the Government recognise as a potential weakness in the Bill.
	What is the Government's defence? According to the explanatory notes,
	"the Department's view is that the different treatment"-
	Members should note that it is acknowledged to be different treatment-
	"of people living at home is not discriminatory. This is because the policy underlying the different treatment pursues a legitimate aim in a proportionate way."
	I do not follow those two sentences. The explanatory notes state that the Department's view is that the different treatment is not discriminatory, and then state that it is discriminatory, but that the discrimination is justified
	"because the policy underlying the different treatment pursues a legitimate aim in a proportionate way."
	Having acknowledged that the treatment is discriminatory, the Government then say that the discrimination, despite being contrary to the ECHR, is justified because in the Department's view, or more precisely the view of the Prime Minister-I do not believe for a moment that the policy had its origins in the Department-
	"the different treatment pursues a legitimate aim in a proportionate way."
	Let us consider what is the "legitimate aim", and whether it is, in truth, proportionate. According to paragraph 23 of the explanatory notes:
	"The key aim...is to enable, support and encourage more people to avoid or delay entering residential accommodation."
	That is set out as the objective of the policy. Let us now consider how effective, according to the impact assessment, that policy will be. According to the assessment, the Government believe that 2,000 of the 277,000 people affected will switch from residential care to care at home as a result of a policy whose purpose is
	"to enable, support and encourage more people to avoid or delay entering residential accommodation."
	The Government's proposition is that they want to delay people's entry into residential care. Their own assessment of the effectiveness of that policy is that it will stop 2,000 people entering residential care. The question for the Committee and, I suppose, ultimately for the European Court is whether the Department is right in saying that that is proportionate.
	What the Department is doing is violating rights under article 14. The Government cannot argue that they are not violating those rights. Indeed, they have acknowledged that they are doing so, but claim that that is justified by the policy objective, which they describe as proportionate. When the policy objective is measured for its effectiveness, it is shown to involve 2,000 people. The rights of all the other people in residential care-there used to be roughly 500,000, and I would guess that the figure is still the same-are being violated. Those people are being discriminated against so that 2,000 people-according to the Government's own assessment-can be prevented from entering residential care.
	I invite the Committee to reflect on whether the defence of the policy set out in the explanatory notes stands up. My hon. Friend has already given his assessment of the two pages in which the Government have set out their position, which might be described as "Methinks they do protest too much." The Government have acknowledged a violation of rights, and have justified it on the grounds of the delivery of a specific policy-the policy being that 2,000 people's care arrangements will be changed, but the rights of 500,000 will be violated so that those 2,000 can benefit from the Government's policy change.

Stephen Dorrell: My right hon. Friend and I are not the only ones who think that there is a serious argument to be answered. The Government clearly share that view. I invite him to assess exhibit A: the explanatory notes, in which the Government have devoted two pages of typescript to explaining why they are safe under this exposure.
	Let me now deal with the second amendment. The two are linked. As I have already pointed, in assessing the principle of proportionality we must first assess the 2,000 people against the 500,000. We must then assess the 2,000 against the £500 million that are being spent on meeting this policy objective. Is the Bill proportionate, given that it has assessed 500,000 people against 2,000? Is it proportionate when it is recognised that the public spending cost of the Prime Minister's commitment to achieving the change in care arrangements for 2,000 people is, according to the Government's own estimate, £500 million?
	I do not believe that the Government have delivered their estimate of cost beyond the two-and-a-half year horizon. As my hon. Friend the Member for Eddisbury pointed out, if we look beyond that horizon, the £500 million will increase geometrically when the behavioural consequences of the measure are taken into account. According to Lord Lipsey's analysis of behavioural change and its financial consequences, the policy will result in a public spending cost well north of £1 billion. I invite the Committee to consider again whether that is a proportionate way in which to deliver the policy objective of enabling, supporting and encouraging
	"more people to avoid or delay entering residential accommodation",
	given the Government's belief that 2,000 people will be affected.
	Enlarging on the spending element, my hon. Friend was right to observe that apart from the principle of article 14 of the ECHR, there is the further question of affordability, value for money and the policy assessment of that £1 billion expenditure. We should bear in mind not just the general financial environment with which everyone is familiar, but the fact that the context of the Green Paper that the Government presented last July was correctly recognised to be the demand pressure, and therefore the spending pressure, that is already building in this sector, reflecting rising demand for social care, and rising expectations about the standard at which that care will be delivered to the next generation of elderly people.
	That is why my hon. Friend is entirely right to ask for a proper statement of the Bill's financial consequences looking beyond the current two-and-a-half-year horizon. We should remember, of course, that the projection by Derek Wanless did not confine itself to two and a half years, but looked forward to 2020. If my memory serves me well, he envisaged the cost of social care rising from 1.2 to 2 per cent. of GDP over that period-in other words, a marginal, additional cost merely to maintain the current level of social care delivery of 0.8 per cent. of GDP. My hon. Friend will probably remember better than I the current size of GDP, but such a percentage must equate to about £20 billion-and merely to maintain the current delivery of social care.
	Despite the words in the Green Paper and the weasel words of the Minister from the Dispatch Box when he tried to evade the point, the Government are encouraging people to believe that the underlying rising demand for social care cannot be met on the basis that it all be paid for by the taxpayer. The Government are now half promising, however, that the taxpayer will meet the bill, which will further constrain our ability to deliver on the rising amount and quality of care that we all want.

Stephen Ladyman: I was not going to comment, but I will now because the right hon. Gentleman has gone into party political matters. Is it not a little strange for him to plea in aid Wanless and talk about the rising costs over 20 years of social care, given that the solution proposed by Wanless-a reform of attendance allowance-is the one policy that his Front Bench opposes?

Phil Hope: Nothing has been rushed out from the Box. One might argue that it could have been, but no doubt there was confidence in my abilities to answer these questions fully and thoroughly by referring directly to the statement that we put to the Joint Committee on Human Rights. I think I have put that matter to rest. Amendment 31 calls for an annual report on compatibility, but that is an unnecessary requirement because the Bill is compatible.
	Amendments 27 and 45 would require the Secretary of State to report to Parliament annually on the costs of providing free personal care at home, the estimated costs of that in future years, and the number of people who receive personal care in each local area. The hon. Member for Eddisbury (Mr. O'Brien) made a number of detailed points about the impact assessment. He repeated a number of the answers I had given to him via written questions, and he went on to make a series of interesting extrapolations, because the impact assessment is in place for only two and a half years. I want to reiterate a point I have made to him on the Floor of the House and in writing: the impact assessment covers only the period from October 2010 to the end of 2012-13. Estimating beyond that point is problematic because of the uncertainties involved. As I said in respect of previous amendments, the proposals in this Bill are a step towards having a fully integrated national care service, at which point a different set of assumptions will need to be applied, and therefore the hon. Gentleman's extrapolations will not apply.
	I also want to emphasise to the House-the hon. Gentleman acknowledged this in moving the amendment-that we have committed to reviewing the implementation of free personal care within the first 12 to 18 months of the policy coming into force. After that review, it will be possible to reconsider the predicted costs of delivering free personal care and the conditions for eligibility, if necessary.
	If the costings for the first year prove to be accurate, it would be an unnecessary burden on local authorities for them to have to produce data to enable the Secretary of State to report to Parliament annually on this matter. Such a report would require a greatly increased volume of data collection by local authorities, which I think both Government and Opposition are keen not to impose. There will obviously need to be some increase in the amount of data collected by councils in order that the delivery of free personal care can be accurately considered, and we are currently consulting on what data would be needed and how the extra data might best be collected so that the extra pressure on local authorities is minimised-an aspiration that I think both Government and Opposition would support.
	On the basis of my responses, I ask the hon. Gentleman to withdraw his amendment.

Stephen O'Brien: This is a very important group of amendments, because we have been discussing the preparedness of the Government-their having a thorough understanding of the technical detail in advance of laying this before the House. In respect of seeking a derogation from compliance, under the Human Rights Act 1998, to the European convention on human rights, the Government have yet to convince us. Therefore, we will seek to divide the House, not least because of all the arguments of reinforcement put forward by my right hon. Friend the Member for Charnwood (Mr. Dorrell), who is a former Secretary of State, and also because the Minister did not give a sufficiently robust answer on the cost-benefit question-on the argument about just 2,000 people benefiting from this, weighed against any increase in access.

Stephen O'Brien: As the Minister has said, additional data collection of some nature will have to be done. The scale of that will have to be measured against the need to make sure it is efficient. However, the blunt truth is that local authorities have been consulting us, and expressing their anxiety and concern about the drafting of the Bill.
	However, we wish to divide the House on amendment 31 on human rights convention compliance. The Government have not made a good enough case. It is very important that we test the opinion of the House, not least because all of us as legislators have a fundamental duty to get this specific aspect of the Bill right, and we want to give the many experts in the other place the opportunity to discuss it, and we also want them to see that all the arguments have been fully aired. The Government have such a weak case that we need to record our concern. That is why I shall press the amendment to a Division.

Question put, That the amendment be made.
	 The House divided: Ayes 197, Noes 287.

Stephen O'Brien: Amendment 17 would remove new subsection (4C) and amendment 18 would change the word "undergoing" to something that we think will improve matters. I shall have explained where the Committee's opinion may best be tested by the time I conclude my remarks.
	The Committee will see that, once again, the Government are falling over themselves in the drafting of this clause. Bad drafting is of course indicative of bad legislation, and the circumlocutions in this provision are a mark of the Government's political motives, which we have already discussed. How would a lawyer define, for instance, a
	"process designed to maximise the person's ability to live independently"?
	Marriage would seem an obvious example of such a process, but I cannot imagine for a second that we will have local authorities mandating that. This is, of course, a legislative reference to reablement. I am not convinced, in truth, that reablement needs to be on the face of the Bill. It does not need legislation to make it work, of course, and surely that should be the test of access to the statute book.
	More worryingly, the way that the Bill is drafted means that it does not allow a local authority to refuse to provide care until the reablement process has occurred. For example, let us say that Mrs. X has suspected critical needs. She applies for an assessment, which takes three weeks-that is not unusual. She is told that she needs reablement, specifically a stair lift and a walk-in bath, which might normally take a further month to purchase and install-let us hope so. It is January, and the council's budgets are tight, so it slows down the process in the knowledge that it does not have to start funding her until the reablement has, in the terms of the proposed new subsection, been undergone. Mrs. X has three months without the care that she needs. That is a legally enforceable event under the Bill as drafted, hence my criticism.
	Will the Minister confirm whether the Bill would take precedence over section 47 of the National Health Service and Community Care Act 1990, notably subsection 1(b), which states that a local authority must make a decision as soon as an assessment is carried out, and subsection 5, which does not
	"prevent a local authority from temporarily providing or arranging for the provision of community care services for any person without carrying out a prior assessment"?
	The Minister has confirmed in answer to a parliamentary question that
	"there are uncertainties about the long-term impact of re-ablement on the need for care, we cannot make an accurate forecast at this current time."-[ Official Report, 14 December 2009; Vol. 502, c. 764W.]
	So much for evidence-based policy. Amendment 18 is the amendment that the Committee might want to see tested.
	Amendment 19 asks how many rounds of reablement people will get. In a response to a parliamentary question, the Minister said:
	"There are currently no proposals to restrict packages of re-ablement."
	He went on to say, however:
	"It will be for councils to determine who might benefit from this intervention and whether it is appropriate to repeat this at a later date."-[ Official Report, 8 December 2009; Vol. 502, c. 291W.]
	Does that mean that the Government will fund reablement that goes outside the indicative grants to local authorities?
	Amendment 20 would prevent reablement from including an informal carer. Will the Minister confirm that reablement will never include an obligation on a family member to take up informal caring responsibilities? Returning to the question of personal care, it seems that carers will continue to be taken into account in the assessment of whether someone has critical needs. The Government's estimate is that only 50 per cent. of carers for people with critical needs and only 5 per cent. of carers for people with moderate needs will give up that informal care when they see that if they do that care will be provided free of charge. Do such small figures hold water when it comes to the points made by my right hon. Friend the Member for Charnwood (Mr. Dorrell) earlier?

Stephen O'Brien: That might well be the case if the person for whom care and support was needed was the cause of the delay. I suspect that that would cause some of the support that would otherwise be given free of charge not to be available anyway, because the person would not be ready to accept that level of care. The issue is the provision of care and what starts the requirement, under law, to make that care, which will be free of charge, available. That is what we have been concerned about. There is an ambiguity, to say the least, and probably an uncertainty, in the way in which the legislation is drafted. I do not think that this amendment is hugely challenging or controversial. It is, I hope, trying to give the Government's intent a better chance of being borne out in how the wording leads to decision-making behaviour from the people who will interpret the Bill in an administrative or legal capacity rather than necessarily any behaviour from those who are looking to receive the care.
	Amendment 21 is a probing amendment to ask the Minister to clarify who will be eligible for such care, and amendment 43, tabled by the Liberal Democrats, who will address the points that it raises, is on the question of palliative care. I am in sympathy with it and supportive of it. The regulatory impact assessment says that people receiving palliative care would be excluded from reablement. That seems quite harsh. As Help the Hospices has said:
	"people can receive palliative care alongside curative treatment (it's certainly not an either/or) and people can also receive palliative care for prolonged periods of time (for some, such as younger people with life limiting conditions, such care can go on for many years)".
	I shall ensure that the Liberal Democrats have the chance to develop that point, but I think that it is important that we recognise it. It is a powerful point and we are grateful that they have tabled that amendment.
	The Minister stated in an answer to a parliamentary question on the number of cases in which people received palliative care that he had no idea what the median, mean and maximum life spans are for people receiving palliative care. I hope that he will be able to expand on the answer that he gave me on 7 December. That issue, in itself, will be of concern.
	In conclusion, as I want to keep the introduction to these amendments relatively brief, I think that the technical way to do this will be formally to suggest that although I will be happy, with leave, to withdraw the lead amendment in this group, I hope to have the opportunity to push amendment 18 to a vote and to test the opinion of the Committee on it, unless we hear some staggering response from the Minister, which is not expected.

Phil Hope: This is an important group of amendments. The policy that underlies the measures in the Bill has two clear strands-free personal care for those with the highest needs who live in their own homes, and a package of intensive support or reablement to help people to remain at home for longer. Reablement services are offered by some councils, but it is important that local authorities across the country continue to develop and improve those preventive services. We know that with a six-week package of appropriate reablement measures many people would be able to reduce their dependency on care services and therefore live more independently. It will not always be appropriate for someone to undergo a period of intensive support, depending on their individual circumstances. That is why we think that local authorities should be given the discretion to make that judgment and to provide a reablement package as a precursor to arranging a package of personal care for the individual where that is thought to be necessary. I want to make it clear that, as my hon. Friend the Member for South Thanet (Dr. Ladyman) rightly said, the measures give local authorities permission to choose to operate in that way.
	On the worry that the hon. Member for Eddisbury (Mr. O'Brien) described, and the example he gave, the immediate needs of individuals would be met while they were undergoing reablement. A more detailed assessment would then be undertaken once reablement was completed. The detailed work on the scheme would not be included in the Bill but would be a matter for guidance, drawing on professional expertise and the views of various stakeholders. Removing such an express power by accepting amendment 17 would, I fear, do nothing to encourage local authorities to develop further their reablement services. It would also fail to encourage investment in services that help people to improve their personal situation and help to prevent it from deteriorating and their care needs increasing. That is one crucial reason why I urge him to withdraw that amendment.
	Amendment 18 would similarly fail to encourage individuals-I think this is the point that my hon. Friend the Member for South Thanet was making-to make the best use of the reablement services available to them. The amendment would mean that a local authority could make free personal care conditional not on an individual undergoing reablement, but merely on undertaking to do so. In other words-this is an important point, and my hon. Friend was right about this-individuals would not need actively to undertake reablement to receive free personal care, but would need merely to undertake to local authorities that they would do so. Therefore, that reablement might never take place.
	Effective reablement relies upon sensible and effective decision making by local authorities, by people who need care services and by their care partners. Reablement packages need to be put in place and need to be undertaken to assist people in living their lives fully and in reducing their dependence. The amendment could result in a reduction in partnership working between the individuals who need care and their local authority. It could also result in authorities beginning to work up reablement packages that the relevant individuals have no intention of taking up. The amendment would not have the effects that we would wish to see of ensuring that people access and use reablement packages as a critical part of the whole system of improving care for people and, indeed, providing free care for the people with the highest needs.
	Amendment 19 would change the description of one of the potential eligibility criteria that may be set out in regulations. It would change the words
	"a process designed to maximise the person's ability to live independently"
	to
	"at least one process designed to maximise the person's ability to live independently".
	That process, which is described in new subsection (4C), is more commonly referred to as reablement. Details of what might be included in a package of reablement will be laid out in regulations or in guidance. We intend for the process to be a single process, but it could involve a range of interventions and support such as home adaptations, the installation of telecare and sessions with an occupational therapist or physiotherapist. There is a risk that, if the amendment were accepted, local authorities could use the wording "at least one" to delay giving people the free personal care that they need indefinitely. Clearly, that is not the intention underlying the Bill.
	The effective and appropriate use of reablement services can help individuals to reduce their dependency on care services and can increase their ability to live independently at home. However, where an individual still has high personal care needs following reablement, they should receive the support they need to meet those personal care needs. That is why we ask that amendment 19 should be withdrawn.
	Amendment 20 addresses the issue of carers. It would insert the wording:
	"Any process under subsection (4C) may not be contingent on the activity of, or acquiring, a carer."
	The amendment does not make clear the extent to which carer activity, which is what it describes, would be excluded. Would knowledge and expertise be excluded, or only direct help with day-to-day living? If the amendment seeks to exclude carer involvement when reablement packages are designed, that could lead to a reduction in partnership working, which we all agree is vital, between the local authority and the carer. That could result in a diminished outcome for the individual who uses the services. We all know that the role that carers play is absolutely vital, because they often have invaluable knowledge about the care requirements of the person for whom they are caring. Those requirements need to be taken into account when a reablement package is designed.
	Even in a situation where carers would still be able to input their knowledge and expertise to design reablement packages, it would be difficult for them to be assured that that was being carried out appropriately if they were not involved in the reablement activity, where they wished to be.
	Carers' involvement in reablement is crucial, when that is beneficial to the individual being cared for. They have an invaluable role in supporting the people for whom they care, and in working with local authorities and care providers.
	I emphasise that the Bill does not seek to place additional burdens on carers, but neither does it seek to exclude them from working with councils to achieve the best outcomes for the people for whom they care. Therefore, we believe that it is important that local authorities continue to work with carers on behalf of those with the highest needs who are eligible for free personal care at home. Given my explanation of the clause, I ask the hon. Member for Eddisbury to withdraw the amendment.
	Amendment 21 purports to extend the potential for local authorities to offer reablement to all those with care needs under the guidance issued under section 7 of the Local Authority Social Services Act 1970. The concern, apparently, is that the guidance should set out how the care is to be made available, and how needs are to be assessed.
	However, local authorities are already required to act under the general guidance of the Secretary of State in discharging their social services functions as set out in the 1970 Act. That includes guidance covering the principles of assessment and the commissioning of services.
	The details of reablement services will be set out in guidance, but the services are designed to help people maximise their skills for living more independently. We all know that they are a valuable part of helping people to live at home for longer. Local authorities are free to offer reablement to anyone who they feel may benefit. Amendment 21 potentially restricts local authorities' provision of reablement services only to those who have existing care needs. I think that that would go against the very important trend towards universal and preventive services.
	Amendment 43 would prevent regulations from authorising local authorities to make reablement a condition of free personal care in certain circumstances, namely when a "registered medical practitioner" or other "registered practitioner" thinks that the process will be of
	"limited or no benefit, or detrimental to the health of the patient, or will not alter their care needs."
	I hope that the hon. Member for Leeds, North-West (Greg Mulholland), who speaks for the Liberal Democrats, agrees with me that local authorities are best placed to decide whether a package of reablement would be beneficial before an individual receives personal care support free of charge.
	It is obviously important that local authorities do not force people to undertake a reablement package unnecessarily. We expect councils, when they are deciding whether reablement is appropriate, to consider in a sensitive fashion the overall benefit and impact of such a package, and to work with the patient's family, GP and others to assess that person's suitability for reablement. That may be particularly important when a person is undergoing palliative or end-of-life care.
	I know that one of the concerns about the Bill is that reablement will not be available for those undergoing palliative care. I can assure the House that, where councils believe that reablement might benefit a person undergoing palliative care, then they may offer it. However, if the person is unlikely to benefit, he or she should not be forced to undergo reablement merely to qualify for free personal care. All the detail of that will be covered in guidance.
	Ultimately, local authorities assess people's care needs and their eligibility for care and support, so it is right that they should be able to make decisions about the services that might be appropriate, in conjunction with other relevant partners in care.

Phil Hope: I am grateful to the hon. Gentleman for that response. I think that it is right that local authorities should be able to make decisions about which services are appropriate, but they must do so in conjunction with other relevant care partners.
	I thank hon. Members for raising these issues to do with reablement. I have spoken at length because it is important that the whole House understands our intent and how the proposal will operate. All the details will be addressed more fully in the guidance accompanying the regulations, and I hope that what I have said will persuade the hon. Member for Eddisbury to withdraw his amendments.

Stephen O'Brien: I am grateful to the Minister, who sought to address a number of issues that we raised in relation to this group of amendments. I note that on his amendment, the spokesman for the Liberal Democrats, the hon. Member for Leeds, North-West (Greg Mulholland) expressed himself relatively satisfied with the Minister's approach.
	I indicated earlier in my remarks that the amendment on which we should test the opinion of the Committee was not 17, which happens to lead the group. I beg to ask leave to withdraw the amendment.
	I intend to press amendment 18 to a Division, but I will say whatever I have to say at the right moment, to make sure that that is clear.

Stephen O'Brien: I am clear, Sir Michael, that I can, thankfully, trust the Chair to do just that.
	It is important to ensure clarity because the reablement process is, as the Minister made clear, in the hands of and, in many ways, in the gift of the local authority, the providers. In the provision of wheelchairs, for example, people may fall between various providers. I am anxious about the trigger mechanism that gives people their expectation and their entitlement, at a time when they are very vulnerable and need the greatest possible certainty, together with their carers who, as the Minister rightly said, will continue to be part of the process.
	It would be useful to register our concern that the word "undergoing" is not sufficiently clear in the present drafting, and press the amendment to a Division, not least so that anyone reading our proceedings with care in another place will be able to make sure that the trigger mechanism is properly analysed.
	 Amendment, by leave, withdrawn.
	 Amendment proposed: 18, page 2, line 1, leave out 'undergoing' and insert 'undertaking to undergo'.- (Mr.  Stephen  O'Brien.)

Question put, That the amendment be made.
	 The House divided: Ayes 183, Noes 285.

Stephen O'Brien: I beg to move amendment 42, page 2, line 27, at end insert-
	'(1A) The provisions of this Act come into force on whatever day the Secretary of State appoints by order made by statutory instrument.'.
	The amendment would quite simply enable the Secretary of State to appoint the day on which the Act would come into force. It might be the same day that it receives Royal Assent, as I assume is the intention, or it might be another day. Will the commencement sections or other sections of the amended existing legislation require the Secretary of State to set out commencement provisions for the measures in the Bill? Can the Bill commence before the regulations in clause 1(4) are passed? That harks back to some of the other points that we have made about the rapidity with which we are having to consider the Bill without some of the necessary supporting documents, research and basis.
	It is worth pointing out that this is the only piece of primary legislation sponsored by the Department since 1997 that includes no commencement provision, which reflects on the nature and provenance of the Bill. The reason for the amendment is that I wish to cause the Secretary of State and the Minister to pause for thought when it comes to putting it into action. I hope that just for a moment, they will contemplate what a mess has been occasioned by the desperation of a Prime Minister anxious to use the final moments of a Government and a Parliament to rush through legislation that appears to have been electorally driven.
	We have looked as best we can at the Bill to scrutinise it carefully in the very limited time that we have had available. An important point is that we were up against the incredible tightness with which the money resolution was framed, which understandably and rightly excluded many amendments that we wanted to table. Many people outside this place wanted them tabled, because they have a great need to understand how the system will operate in practice and they need clarity and certainty. We are dealing not only with people who care but with people who have care needs, and there is no substitute for the clarity and the security that it occasions for people in that circumstance.
	As Labour Members have made clear, and as the Minister has made clear in answers to me, the Government have assessed the funding only for two and a half years. We have had some discussion about that. That suggests that although the Bill is an interim measure, which is at odds with the fundamental point that it is meant to be consistent with the Green Paper, it has turned out to be something of a spatchcock of legislation squeezed into the end of this Parliament.
	I am keen not to detain the Committee, because we have put on record many times our view about the litany of broken promises, from the then Prime Minister Tony Blair promising in 1997 to sort out social care all the way to today, 13 years later. I hope that the Minister will take the chance provided by the amendment to contemplate what many people have said about the Bill, which is that it has driven a coach and horses through the Green Paper process. I know that he resists that view, but it seems real among those who take the closest possible interest in these matters. Niall Dickson of the King's Fund, shortly to be of the General Medical Council, said in response to the Prime Minister's announcement of the policy:
	"The problem is these latest proposals seem to have been hastily put together and appear to cut across the options set out in the government's own Green Paper. After all, the government has only just finished consulting us on the very different proposals set out in that document."
	The English Community Care Association said that
	"it is unhelpful to have just one piece of the jigsaw".
	The Association of British Insurers noted:
	"It is regrettable that the Personal Care at Home Bill undermines the Government's own Social Care Green Paper",
	and the Equality and Human Rights Commission expressed the concerns that I set out when discussing the previous group of amendments. Lord Lipsey, who was famously a member of the royal commission on long-term care and is usually no enemy of the current Government, put it most clearly when he said:
	"What has gone wrong is that in the middle of the consultation...the Prime Minister has declared"
	this Government policy.
	The reason for this amendment is to give those hon. Members with a keen interest in how the Bill has been put together a chance to talk of their regret about how it has been done, not necessarily its objectives. Many of us agree with its objectives; the trouble is that it does not sit well in the context that we have all been working towards and the attempt to build a consensus. I hope that the Minister will come to recognise that there is a price to pay for political tribalism, given his reluctance to contemplate the merits of our home protection scheme. Taken together with the provisions in the Bill and other measures urged on me by the hon. Member for South Thanet (Dr. Ladyman) among others, that scheme could provide the whole picture, rather than just one piece of the jigsaw. That is why we have tabled the amendment. We do not want to see a postponement of implementation, but this Bill should be seen as part of a consensual process, as far as we can achieve that. In the absence of such a process, and with the Government taking such a tribal approach, we have had difficulty scrutinising the legislation. Its provenance is more electoral and party political than policy driven. The amendment would give the Government chance to pause and contemplate the fact that they should have set the Bill in a broader context. I invite those who think that it could have been handled better-perhaps as Lord Lipsey has suggested-to support the amendment.

Stephen Dorrell: The Minister has said several times that the Bill concentrates money on those with the greatest care need. Is that true? The resources are in fact being channelled to those with the greatest care needs that can be met at home, but those with the greatest care need are those whose needs cannot be met at home. Their needs must be met in residential care, and for them the means-tested system will continue to operate.

Stephen O'Brien: This is slightly depressing. The Government have chosen to discuss what they regard as a prime ministerial flagship Bill for only one day on the Floor of the House. The Bill was put together at short notice and flies in the face of the processes that the Government had already set up through a Green Paper. All sorts of people outside this place, including those who give a lot of their time to caring for vulnerable people and the many people in the various categories of need, have grave concerns about it. There is a big question mark about the legitimacy of the legislation. We have properly asked questions about its compliance with the European convention on human rights and my right hon. Friend the Member for Charnwood (Mr. Dorrell) rightly identified and reinforced those discrimination issues in his argument. However, after all that, we end up with the Minister somewhat charmlessly deciding that it is really rather an insult to subject the legislation that he is meant to be defending to scrutiny. Of course, the only way in which one can do that is by way of amendment-I dare say that that would be clear in the minds of most hon. Members. The fact that the Bill has been rushed out and is contrary to the run of the Green Paper means that many questions have to be asked.
	In my introduction I simply proposed my amendment 42 and said how it is framed, so it hardly warranted the Minister's quite extraordinary rant. It is framed so as to allow the Committee an opportunity to test whether it feels that the process by which the Bill has come about, the time in which the consultation will take place-it will not finish until February-and the results of the assessment of that consultation, which will be important for so many people representing various stakeholder and constituency interests, have been sufficiently thought through and well framed for us to produce good legislation, which we can pass from this House to the other place to look at. We have set up a number of things that I hope those in the other place will find useful, as hooks for their discussions, so that their expertise can be brought to bear.
	I hope that the record will show that, far from not being supporters of the Bill, we are indeed supporters of the Bill. We are also keen to ensure that it works for the purposes that it is intended to work and for the people for whom it is meant to work. That is why we have done what we had to do in this Committee stage. That is precisely why we are all sent here: to do our legislative duty. I am surprised that the Minister found that insulting and felt that it warranted his outrageous rant, which I thought was undignified and not worthy of the office that he is privileged to hold.
	Therefore it is vital that we give the Government and the Secretary of State a chance to pause for thought. Has this Bill been sufficiently well framed, in its timing and for the process by which we are drawn to this place to scrutinise legislation? Is it sufficient for a Government simply to say, "We want it to happen; therefore it will happen"? Or, at this late stage in this Parliament, should we be doing our duty, by looking at the constituency that the Bill is meant to represent? The Minister has not given an adequate answer to why 2,000 people becoming net beneficiaries is a sufficient benefit, as opposed to the costs, to warrant the £500 million being pledged, not least because money is to be scraped from savings by local authorities-local authorities are meant to be serious providers; they are also meant to have the opportunity to save-from budgets that are often already pared down to the bone.
	It behoves us to give the Committee an opportunity to express its opinion. Had the Minister chosen to take a slightly different route in responding to this debate, we might have been more amenable to building a consensual approach, but that does not seem to be on offer. The Committee should have the opportunity to register its distaste at how the Government have sought to treat us in dealing with the amendment and at the Minister's response. I therefore seek to press the amendment to a vote.

Stephen O'Brien: H.G. Wells famously once said:
	"In England we have come to rely upon a comfortable time-lag of fifty years or a century intervening between the perception that something ought to be done and a serious attempt to do it."
	Perhaps that is a little harsh, but we all remember Tony Blair's pledge at the 1997 Labour party conference that he would sort out social care, and yet now, nearing 13 years later, the Government are still dealing with only a relatively small part of the overall picture, of the demand that has been coming from all quarters for many years.
	Broadly, we have had a good series of discussions this afternoon. Time constraints have, however, been placed on us by the Government's somewhat bizarre programming decisions. This is not a free-vote issue, and nor is it a matter of national security, so it is puzzling that we have been given only this brief opportunity of one day to cover all the remaining stages of the Bill on the Floor of the House, rather than having the fuller scrutiny it would have received with a longer Committee stage upstairs and potentially a full Report stage. Frankly, we have ended up little, if any, closer to the clarity we need on some issues, such as the true costs of this measure-not only the basis for many of the estimates, but the costs post-2012 and the potential costs if the estimates are wrong. We expressed sufficient doubts to raise some serious questions about that. The Government have given little hope to local council tax payers and service users, who are set to bear the brunt of any funding shortfall.
	The potential legal loopholes in the Bill are very worrying for the added costs they would bring, such as in respect of care homes restructuring, residential care qualifying as "home", and, of course, the human rights implications of the measure, which we have rightly discussed at length. A number of questions remain about reablement: who will get it, whether it is carer-dependent, and whether the costings are accurate and who will pay if they are not. Most disturbingly, the Government have refused to budge on their position regarding people with palliative care needs, although the discussion we had on that gives us some grounds for optimism that the situation may improve.
	The proportionality of this legislation remains in serious doubt. The benefit estimated-that word again-by the Government is only £190 million a year, less than a third of the cost. The measure impacts on only 279,000 people, of whom 166,000 already receive care for free. It makes a difference to only 110,635, less than 2.5 per cent. of what the Government have said are the 6 million people in England with care needs.
	The Bill makes no attempt to allow the whole gamut of social care to be addressed in the future. The Government have our home protection scheme before them. They have made various criticisms, but none of them amounts to anything other than the usual political rhetoric. As we have made clear, that scheme only addresses residential care, but their policy addresses some very narrowly defined domiciliary care. One could seek to put those two together and build a more consensual approach to trying to plug all the gaps and address the whole waterfront, as it were, of social care. In that, one can see the prospect of an opportunity for an approach that is a little less adversarial than, sadly, we have experienced, particularly in terms of the last group of amendments, which was a shame.
	The Government have done little to reassure us that they know the meaning of the word "free" in terms of public policy: "free" means that somebody else pays. In this instance, they are pledging to cut money. A number of budgets have been mentioned, and they have sought to give rebuttals. We will study very carefully the rebuttal put forward at the Dispatch Box on research budgets, such as those targeting diseases such as dementia and cancer. There has also been a pledge to cut some money from the NHS IT programme. As Ministers are aware, I have been ferreting around, using parliamentary questions to try to get some answers, but the Government have never come clean about what contractual break clauses there are in NHS IT, or in some other contracts to do with the supply of swine flue vaccine, which I know my hon. Friend the Member for South Cambridgeshire (Mr. Lansley), the shadow Secretary of State, looks forward to receiving in terms.
	It was important to make sure it is recognised that the Government have not pledged to support this policy with money from the centre, other than some proportion of it. They are also relying on the efficiency savings they simply announce can be made from local government-a full quarter of a billion pounds.
	Of course, I wish that the Government had taken the opportunity to look beyond the narrow confines of this particularly electorally inspired Bill, whose provenance was the Prime Minister's comments at the time of his Labour party conference last September. With the money resolution being as tight as it was, there was not the opportunity for them to undertake full and proper consideration, not least of our home protection scheme. We would have enjoyed having the opportunity to debate and propose that. However, that is how it is, and we recognise that it will be difficult to persuade this Government to do what we hope they will do, which is to bring together a number of us to try to find some way to deliver on the very legacy that the Secretary of State claims he is trying to secure.
	The Secretary of State says that he seeks some "unstoppable momentum for legislation" in this area. It is impossible to know now whether the Bill will complete all its stages, given that it must go through the upper House and that we have no idea when the general election, which must come before June, will be called. Thus we cannot be sure whether this Bill is "unstoppable" or whether it represents "momentum"-we are not even sure that it will be legislation. What we do know is that establishing unstoppable momentum requires a degree of consensus. If the Government genuinely wish to take that approach, I would be more than happy to be asked to participate in such a discussion, as I dare say those from other Opposition parties would.
	As the measure goes strongly against what the Government set out in their Green Paper, we have faced the difficulty of trying to understand how to place the Bill in the context of the wider reform that so many of us seek and know must be addressed-our political generation has no option but to do that. In our consideration of this Bill in the time available to us, we have faced particular difficulty in understanding the true evidence that lies behind it and the calculations of the costs. A lot of us, including many outside this place, have had desperate concerns about the thoroughness and robustness of the impact assessment, even when the Government have sought to reissue some of the numbers. None the less, we have tried to give the Bill reasonable scrutiny.
	Interestingly, the Bill may face its biggest difficulty when it goes to another place. The Government may well have a tougher time of it there, where they have some noble "Friends"-I assume that that word still applies-in Lord Warner and Lord Lipsey who have certainly, in comments to date, been squaring up for something of a fight on this. Lord Lipsey has called the Bill a "gimmick" and said that it is
	"bad policy but also a very bad way to do policy just to find a...highlight for your Labour Party conference speech."
	Who knows, perhaps everything has changed in Lord Lipsey's mind after the apparently rousing call to arms by the "Mr. I'm a team player" Prime Minister at the parliamentary Labour party meeting last night-we will wait and see.
	In advance of what might be considered in the other place, what matters is that we have done our very best to try to unearth what truly lies behind this Bill and how it will in fact be made to work, given that it is proclaimed to service the needs of some-only some, not all-of the most vulnerable in our country. I am grateful not only to you, Mr. Deputy Speaker, and to all those who have assisted us in going through the process of scrutinising this Bill, but particularly to my many Conservative colleagues who have taken the opportunity to contribute to this extremely well-informed and responsibly discussed debate on an important matter.

Norman Lamb: It is a pleasure to follow the hon. Member for South Thanet (Dr. Ladyman). I absolutely agree with his last point: we must all commit ourselves to finding a sustainable, long-term solution that meets the needs of all those with care needs and not just the small group whom this Bill addresses.
	Let me start by making it clear that there are two other points on which we all agree. I am sure that we all agree on the absolute importance of the idea that any reform should facilitate people's remaining in their own homes for as long as they can. For the group of people who will benefit from the Bill, that will clearly be the case. We must ensure that that principle is at the heart of the final reform that we achieve.
	The second absolutely important principle, which this Bill addresses, is the value of reablement. The Bill recognises that at present we do not do reablement well enough. There are patches of good practice around the country where authorities have been able to demonstrate the enormous potential savings and, more importantly, the dramatic improvement in people's lives of committing properly to reablement. However, in too many parts of the country reablement is not provided well enough. At its best, the Bill provides an incentive to the system to ensure that reablement takes place. That is a good thing.
	Following the debates today and on Second Reading we still have three core concerns, the first of which is affordability and sustainability, particularly given the trend towards an ageing population. We used to be attacked by the Government for our previous commitment to free personal care. Two years ago, we removed that commitment. I took a paper through our party conference, because I reached the conclusion that one could not, in reality, argue the case for free personal care given the demographic changes that we are witnessing. The Green Paper recognises that point, but the Bill shifts in that direction. That causes me real concern, because the cost of the duty to provide free care to the relevant group of people will keep rising.
	The Government have set a cap on the amount that they will contribute, so the other potentially pernicious impact is that if the rest of the funding has to come from local authorities as the numbers continue to increase, something else will have to give. My fear is that, owing to this duty, other vulnerable people who benefit from care from local authorities on a discretionary basis will end up losing their care, or part of it. If the demand is higher than the impact assessment has concluded, the impact will again be on local authorities here and now, and the potential consequences could be very damaging.
	Our second core concern is that the proposal is a partial solution. I think that everyone recognises that. The Government's case is that it is a bridge to reform, but as long as it remains the only reform to have happened, and until we have more comprehensive reform, it will have perverse consequences. As the right hon. Member for Charnwood (Mr. Dorrell) has made very clear, it will provide an incentive for local authorities to push people into care homes. That is not a good thing, because it will change behaviour and will benefit one group of people but not another. Another perverse incentive was mentioned on Second Reading by the hon. Member for South Thanet (Dr. Ladyman)-it will provide a disincentive to people who are considering insuring to protect themselves in old age.
	Another danger, or consequence, of the fact that the proposal is a partial solution is the inherent unfairness in the Bill. Why should we choose to support and provide free care to one group of people-those with critical need who are cared for at home-but not another group who, through no fault of their own, end up having to have their critical needs met in care homes because they simply cannot be cared for at home? That is perverse. Why should one group benefit and not another? The Government have provided no answer to that.
	Our third core concern is whether what is proposed would be the most effective use of public funds. The Green Paper strongly makes the case that in any reform we have a duty to ensure that we use public funds to the best possible effect to achieve the best outcome for all those who have care needs, but the Bill does not do that. The impact assessment confirms specifically that the group of elderly people who would benefit most from the proposal would be the wealthiest.

Norman Lamb: The Secretary of State shakes his head, but the impact assessment makes that clear. At paragraph 5.21, it states:
	"The recipients of free personal care are believed to fall into the bottom, 2nd and 3rd quintiles because even the wealthiest older people (who represent the main beneficiary group) are in the middle of the income distribution of society at large."
	In other words, the wealthiest elderly people are not the wealthiest people in society, but they are the main beneficiaries of the Bill. I find it bizarre that a Labour Government should choose to use available public funds to benefit most the wealthiest older people, given that there are many others with acute care needs. The conclusion must be that that is not the best use of available public funds.
	I am also concerned that the Bill has been oversold by the Government. The Minister again quoted a figure of 400,000 for the total number of people to benefit from free care, and that of course includes those who would benefit from reablement. However, when one looks at the number of new recipients of free care at home, the real figure is 110,000. The Government do not use that figure at all in their pronouncements.
	The Government say that the Bill protects the care of those currently receiving free care, but it is hard to envisage circumstances in which those in critical need who are currently benefiting from care on a means-tested basis would lose that care. Therefore, it is somewhat disingenuous to argue that there is some great benefit for that group. The new recipients of free care will total just 110,000. As the hon. Member for South Thanet made clear, that is a relatively small group, compared with the total number of people with care needs who will have to be supported in any final reform of the system.
	Finally, I find that it strains the use of language to describe this Bill as a bridge to reform. As a sceptic, the hon. Member for South Thanet made the best possible case for supporting the Bill but, whatever happens to it, we must all be committed to a more fundamental reform of the system. I think that we are all agreed on that.
	I want to repeat the case that I made on Second Reading. In this pre-election period, there is a real and overwhelming need for all parties to put aside their differences and to join in a process charged specifically with building and achieving consensus on this matter. I know that that would be supported massively by those groups outside Parliament who represent people with real care needs. Such a consensus would have the benefit of facilitating reform in the next Parliament, and it would also put pressure on whoever wins the next election to ensure that reform takes place.
	The hon. Member for South Thanet is absolutely right to say that the urgency of completing the reform process is overwhelming. We must not allow this Bill to delay that.

Laura Moffatt: I do not care where the Bill was born or who dreamt it up; I am just extremely glad that I have stuck with it, right from the early days of the consultation paper when I considered these matters with my constituents. My constituents do not care either; they are just very pleased that we are able to be here today, giving the Bill a Third Reading. They believe that this is the right thing to do.
	It is easy to over-complicate the Bill. It is also easy to spend a whole day doing down its aims and objectives. We know, however, that it will benefit a significant number of people. Most of us-certainly those of us, on both sides of the House, who have taken a serious, forensic interest in the Bill from the word go-will completely understand that we would love to move straight to a national care system. Anyone who has worked in the care system, as I have, will know that that is our objective. I have to say, however, that the one true thing that the Bill does is to send a clear signal to our constituents that this Government are very keen to ensure that people receive the care that they need, free at the point of use, with the reassurance that they will be able to live their lives out in their homes if that is what they want. And that is what they want.
	 Question put and agreed to.
	 Bill accordingly read the Third time and passed.

Janet Dean: I am grateful for the opportunity to raise what I believe is an unfair and, indeed, immoral situation regarding how we treat students who become seriously ill during their studies.
	Students who develop serious illness, such as cancer, are currently expected to use their student loans to support themselves during their period of illness and treatment. I believe that this is unfair. It is distressing enough for such young people and their families to have to fight serious life-threatening illness, such as cancer, without having the need to abandon their university courses. They need the hope and expectation of returning to their studies when they recover. They want to maintain their place at university, and yet if they suspend, rather than abandon their courses, they are deemed to have income from their student loans. Students are not entitled to claim benefits for 28 weeks, and even after that period, their student loan is taken into account when calculating their benefits. They are deemed to have their student loan even if they do not draw it down. Ultimately, if the treatment is successful and the student recovers to return to university to complete their course, they will have four years of student loan to repay for a three-year degree course. That cannot be right.
	This important issue was raised with me in November 2007 by my constituent, Mr. Ian Leech, on behalf of his 20-year-old daughter, Melissa, who had been diagnosed in August of that year with non-Hodgkin lymphoma. Melissa was a student at Aston university and had been due to begin her third year of studies in September 2007. Mr. Leech contacted me because Melissa's application for income support had been refused because she was treated as if she was merely taking a gap year from university.
	The response from my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt), who was then Parliamentary Under-Secretary at the Department for Work and Pensions, explained as follows:
	"generally, full-time students are not entitled to benefit for the duration of their course, including the vacations. This is because primary financial support for students comes from the educational maintenance system, which is designed for their needs, unlike the social security system".
	His reply went on to say:
	"However if a student is sick for more than 28 weeks, they may be entitled to Income Support and/or Housing Benefit as a disabled student, as long as they satisfy the incapacity test, of course, any income, including a student grant and loan, will be taken into account when calculating benefit entitlement."
	He also explained:
	"If a person qualifies for DLA they are then classed as a disabled student which would give entitlement to Income Support as well as the Disability Premium".
	I acknowledge that my hon. Friend was trying to be helpful, but of course unless someone is classified as terminally ill, there is a wait of three months for them to become eligible for disability living allowance.
	I was most grateful for the meeting that I had with my hon. Friend, who recognised the problem and kindly wrote to Melissa in March 2008 saying that he was aware of other people with similar problems. He promised to have discussions about how the system could be improved and wrote to me in May 2008:
	"Officials are working on the detail of changing the deeming rules so that students who become seriously ill and have not drawn down their student loan are not penalised".
	He added:
	"Assuming there are no major legal obstacles, we hope to implement a change to the regulations later this year".
	Sadly, Melissa lost her great battle and died in May 2008 supported by her caring mother, father and sister. Ian Leech has carried on his fight on behalf of other students in a similar position, and I should like to pay tribute to him for all his work in raising awareness of the condition and for his continued campaign to see fairness for students such as Melissa. His efforts in highlighting the plight of those with non-Hodgkin's lymphoma have been recognised in each of the last two years by the Lymphoma Association.
	Mr. Leech recognises that the problem of student support is complicated and that there are grey areas. In July 2008, he put forward suggestions for income support to become available for the term following the diagnosis of serious illness. For example, if someone was diagnosed in November they would use the rest of their student loan for that term until December and then be eligible for income support. Mr. Leech recognised that there were complications in relation to payment for student accommodation, which is paid in advance in some cases, and in relation to loans for tuition fees paid in advance in the autumn. However, it would be possible for a pro rata proportion to be refunded by the university to the Student Loans Company if someone's studies were suspended.
	I recognise that it is important to distinguish students who have a few weeks away from their studies because of ill health from those who have to take a year off because of serious ill health and treatment. If students are sick for a short time they can catch up with their studies without any extra cost to themselves, whereas those taking a year to recover from illness need to repay at least an extra year of student loan. It should not be too difficult to establish a system that enables medical evidence to be used to distinguish those with short-term illness from those who need to suspend their studies for a year.
	Unfortunately, the hoped-for changes that my hon. Friend the Member for Warwick and Leamington referred to in his letter to me in May 2008 have yet to be achieved. Some changes were made for students who abandon their course or are dismissed from it, but not for those who have to suspend it. Indeed, the changes made for those abandoning their course reflect the suggestions made by Mr. Leech. The Social Security (Students and Miscellaneous Amendments) Regulations 2008 mean that since August that year, when a student abandons or is dismissed from their course, the Department for Work and Pensions takes into account only the quarter that the loan is meant to cover-or if the loan is paid in two or more instalments in the quarter, the period of the quarter that the instalment is meant to cover-not the whole year.
	In November 2008, I received a response from the new Minister at the Department for Work and Pensions, my hon. Friend the Member for Burnley (Kitty Ussher), reassuring me:
	"We believe that there is a strong case for changing the deemed income rule for students who have not drawn down their student funding, fall seriously ill and need to suspend their studies."
	But she went on to say:
	"However, in the current economic climate, every new initiative is being scrutinised and so far it has not been possible to secure the necessary funding to implement the change. Officials will continue to press on with this, but I cannot promise an early resolution."
	You will understand, Mr. Speaker, that both Ian Leech and myself were disappointed by that. After further correspondence with Ministers I was grateful that my right hon. Friend the Minister for Higher Education and Intellectual Property agreed to meet me, together with my hon. Friend the Member for Warwick and Leamington.
	 Motion lapsed (Standing Order No. 9(3)).
	 Motion made and Question proposed, That this House do now adjourn.-( Mr. Blizzard.)

Janet Dean: After the meeting in March 2009, the Minister wrote to the Department for Work and Pensions in support of changes to the benefit rules for those who are absent from their course because of long-term illness, but who remain enrolled at their university so that they would not be classified as being in full-time education for benefit purposes.
	In June 2009, better news came from the Treasury in a letter from the Chief Secretary to the Treasury, which said that
	"in current economic circumstances, all new policy changes need to be thoroughly scrutinised, and affordability must be assured, before any commitments can be made. I will, however, look carefully at the case for this change as part of the Pre-Budget Report."
	This was confirmed to me in a letter from my hon. Friend the Work and Pensions Minister in August 2009 in which she says:
	"Treasury officials have said that they would be willing to consider implementing the change in the next Pre-Budget Report".
	Sadly, changes were not announced in the pre-Budget report, even though I know that my hon. Friend the Minister pressed the Treasury for the funding to implement this much needed change following our meeting early in November.
	Students who become seriously ill are still suffering because the current system lets them down. As Mr. Leech said to me, a student should not be expected to have to endure a long-term illness and use money to live on that they then have to repay. As he says, that does not apply to the employed, the unemployed or the retired. Students are being singled out and persecuted. He also believes that the human rights of students with long-term illnesses are being violated because they are treated differently from other members of society.
	Because of Ian Leech's campaign, students contact him from around the country through the Lymphoma Association, and one such student, Blair Ward, wants her story told. Blair says:
	"Not only am I a student at the University of Central Lancashire, Preston, but I also work part-time as a cashier at Asda at weekends. When I was diagnosed, I didn't work enough hours at Asda to receive sick pay, so I contacted Macmillan who suggested I claim for Employment Allowance"-
	I believe that she means employment support allowance. She continues:
	"I filled out all the relevant forms and obtained the supporting evidence, only to be rejected as a result of my still having a position on my degree course and being classed as a full-time student, even though I wasn't able to attend university, as I was taking time out to receive treatment. Therefore I wasn't receiving any income from either Asda or the Student Loan Company.
	I appealed against this decision stating that I wasn't receiving any student finance and that I had had no income for over 9 months, but again I was unsuccessful. I had to use a huge amount of my savings to buy new clothes for the winter, spring and summer months, as a result of my gaining several stones in weight, which was due to the course of steroids I was put on as part of my treatment. I also had to pay for petrol and the general running costs of my car to get to the hospital appointments."
	Thankfully Blair has now returned to university, but her experience describes how it can be more costly to be ill, with expenses such as travel and personal items, such as clothes.
	Serious ill health is difficult to cope with at any age, but for young people and their families it is particularly tragic. It is bad enough coping with the stress of diagnosis and treatment without the added pressure of the unfairness of the benefits system for students. All Departments now accept that unfairness.
	No one seems to know how many students have to suspend their studies because of serious illness; however, numbers are likely to be small. It is likely that the numbers who have to suspend their courses is less than those who abandon or are dismissed from their courses and have been helped by the Social Security (Students and Miscellaneous Amendments) Regulations 2008. The proposal from the DWP is that employment support allowance for students who suspend their studies because of serious ill health be treated in a similar way. I welcome that proposal and urge my hon. Friend the Minister to ensure that a way is found to achieve justice for students with serious illness. It would be immoral, unfair and unjust not to address the problem.

Helen Goodman: I, too, would like to congratulate my hon. Friend the Member for Burton (Mrs. Dean) on securing the debate. Let me say how much I appreciate her concern and the effort that she has expended in taking up the issue, which stems from the particularly distressing case of Melissa Leech. As my hon. Friend said, Melissa's father Ian has also campaigned vigorously for students who suffer from severe illness that causes them to halt their studies. My hon. Friend outlined the details of Melissa's case and subsequent death, and made an eloquent case, which deserves the fullest understanding. She has also been persistent in pressing the issue of support for students who find themselves in such circumstances. I was also pleased to hear the perspective of my predecessor, my hon. Friend the Member for Warwick and Leamington (Mr. Plaskitt). I had not realised how long the discussion had been going on, so I was pleased to have his input into this debate.
	Let me begin by explaining what financial support is currently available for students, including those who fall ill and are unable to continue their studies because of their illness. As hon. Members will know, the social security regulations were changed in 1990. The automatic entitlement of full-time students of 19 or over to jobseeker's allowance, income support and housing benefit was removed at that point. The Government believe that those who want to take the route of full-time study should become the responsibility of the education system and should therefore not normally be eligible for income-related benefits. That is to avoid duplication of financial support.
	That policy happened to coincide with the introduction, by the then Department of Education and Science, of top-up loans for students and student access funds, which allow colleges to give discretionary payments in cases of hardship. More recently, the Government have introduced the maintenance grant and the special support grant, which are available to those who need help with accommodation and other living costs. They are grants, not loans, which have to be repaid. The special support grant is available to those who receive income support or housing benefit. The Government have concluded that the education system is best placed to provide the primary financial support needed for the entire period of a student's course of study. Such support is designed specifically to meet the needs of students, unlike the welfare system. However, in recognition of the fact that some students have expenses unconnected with their study, those in vulnerable groups retain an entitlement to benefits. They include student couples with children, lone parents, disabled students and people aged 60 or over.
	When a student falls ill, they can be absent from their course for up to 60 days and remain eligible for student finance. If they need extra help, their university or college can make payments from its access to learning fund during that period. If a student is ill for more than 60 days, their local authority can choose to continue paying them student finance, as long as they remain enrolled on their course. However, they may be too ill to continue their course and may need to abandon it. When a student has to abandon their course and needs to apply for welfare benefits, we treat them just as we are required to treat any other person. We must take into account their financial resources and any resource that may be available to them. In the case of a student, that is usually a student loan, which is the main means of financial support for the majority of students. We take into account the period for which the loan has been made, which, as my hon. Friend the Member for Burton pointed out, is not the whole year, but the quarter during which the request for welfare help has been made. We introduced that change in August 2008 in order not to penalise those who had had to give up their courses. At the moment, this applies only if the student ceases to be a student; if they do not cease to be one, they are not under current rules able to claim benefits. This is what my hon. Friend wants to see changed.
	My hon. Friend raised the issue of deeming income. We have a deeming rule for all customers who wish to access benefits. Let me explain why we need to deem available income when it might not have been taken up. Benefits are payable only when no other income is reasonably available, so there are strict rules covering the availability and use of income. For example, someone who has money but disposes of it may be disallowed from benefit because they are considered to have disposed of it in order to claim benefit. Similarly, someone able to obtain financial support from elsewhere but does not do so and then claims benefit may be disallowed because they have other resources available. Anyone who wishes to receive benefits must first show that they have taken up any available financial support. In the case of students, this will be the student loan.
	I do appreciate that a student faced with the appalling knowledge of a possibly fatal illness may want to keep their status as a student in order to hold out some hope for the future. The difficulty at the moment is that there are clear rules covering students, the clearest being that full-time students are not entitled to benefit, including during the vacation period.
	Let me turn to what we could do to improve the situation for students in these difficult circumstances. As a start, I feel we can go a long way to alleviating the problems for students who find themselves in such difficult circumstances by making sure, as far as we can, that they get the right advice at the right time. If students and those who advise them are better informed about the financial support available to them in a range of circumstances then students will be better placed to deal with the financial issues, should they fall seriously ill.
	My officials have been working with their opposite numbers in the Department for Business, Innovation and Skills to improve guidance to universities so that students receive clear and consistent advice. They have also taken advice from the National Association of Student Money Advisers. I would stress the importance of students contacting their college advisers and their student union as soon as possible, and Jobcentre Plus if the student feels that they may be able to claim welfare support. There is a good deal of useful information for students on the Directgov website.
	I appreciate that arrangements for supporting full-time higher education students can be far from clear and straightforward. For example, we make exceptions in the benefits system for certain groups that are considered to be vulnerable, whether they be students or not. Each of those exceptions brings its own particular circumstances that have to be taken into account. This inevitably adds to the complexity of the financial support system.
	Particularly in the light of what has been said this evening, I think it is an appropriate time to consider whether there is any way that we can simplify and improve the transparency of the arrangements. I will explore ways forward with BIS, education providers and student representative bodies.
	I appreciate my hon. Friend's case for dropping the deeming principle in some cases, and I understand that additional costs to the Exchequer are not likely to be large, as such cases are few and far between.